Patent RU-2737585-C2 (RU)
Inventor: PIKIN OLEG VALENTINOVICH
IPC: A61B17/11
Filed: 2020-06-10
Granted: 2020-12-01
Abstract: FIELD: medicine. 
     SUBSTANCE: invention refers to medicine, namely to oncology and thoracic surgery. Cervical esophagus is transected at distance of 2-3 cm from the pharynx with a preliminary dissection of the muscular layer to a submucosal layer. That is followed by forming an esophagus-gastric end-to-side esophageal anastomosis as follows. Cervical esophagus stump is anastomosed to the posterior wall of the gastric graft, wherein the esophagus stump is fixed with three separate interrupted sutures to the posterior wall of the gastric graft, forming an external row of posterior lip of the anastomosis. Further, at 5 mm proximal to the formed outer row and parallel to it, a hole is made in the posterior wall of gastric graft 10 mm long and an internal row of posterior lip of esophageal-gastric anastomosis is formed with five separate interrupted sutures. Gastric graft is sutured transversally by 10 mm more proximally than the previously formed anastomosis opening, the apical fragment of the gastric graft is dissected away and removed. Line of mechanical suture on gastric stem is not covered. Internal row of anterior lip of anastomosis is formed with separate five interrupted sutures with mucous membrane gripping of anastomosed organs. External row of the anterior wall of the anastomosis is formed; an internal row of sutures is covered with three U-shaped sutures: needle prick-in is performed starting at one of the edges of the mechanical suture line of the gastric graft from the side of its front wall under the mechanical suture line. Needle is pricked out from the side of the rear wall. Further, the needle is delivered through the muscular layer of the cervical esophagus in the transverse direction at distance of 5 mm from the seam line of the internal line of the anastomosis and back stroke is carried out needle under mechanical seam gastric graft in direction from rear wall to front. Prick out the anterior wall of the gastric stem is 5 mm from the previous prick in. Suture is taken on the holder and a suture is formed in the same way from the opposite edge of the gastric graft, and a third suture is made between two previously formed sutures. Each suture is taken on a holder and after formation of U-shaped sutures, all three sutures are outside the anterior wall of the gastric graft, which are carried out under the line of the mechanical suture. Then they are alternately tied so that the top of the gastric graft completely covers with its back surface the first row of the anterior wall of the anastomosis. 
     EFFECT: method enables forming an esophagogastric gastric anastomosis on the neck without tensioning the cross-linked tissues, form an esophagogastric-gastric anastomosis with minimal blood loss in the apical gastric graft, provide mechanical strength of the cross-linked tissues by using a transverse stapler suture for suturing, reliable cover of the first row of the anterior wall of the anastomosis even in case of gastric graft deficiency and minimizing development of complications from the esophagus-gastric anastomosis. 
     1 cl, 1 ex, 5 dwg