Abstract:
A surgical method and device for performing colostomy or like surgery in which a sterile, flexible plastic sleeve is slipped over the bowel or colostomy spur and lubricated. The sleeve covered spur is then pulled through the relatively small colostomy incision until the colostomy spur has protruded to the satisfaction of the surgeon. Then the sleeve is pulled completely out of the incision and off of the spur. The sleeve itself is notched at one end to facilitate clamping and tying by means of at least one suture fastened to the sleeve above the base of the notch.

Description:
BACKGROUND OF THE INVENTION 
     The present invention relates to colostomy or like surgery in which a portion of the bowel, referred to as the colostomy spur, must be pulled through a small opening or incision in the abdominal wall. FIG. 1 of the drawings illustrates the basic prior art procedure. First, a large incision (7-10 inches) is made in the abdominal wall 21 to open the abdominal cavity 20. The bowel transection is then completed. The rectum 40 is capped by means of a cover 41 as is conventional. The colostomy spur 60 is then pulled through a relatively small colostomy incision 50 which has been made in the abdominal wall off to one side, away from the major incision. Once spur 60 has been pulled through, by means of a clamp 70 or the like, it is either left in situ or it is matured, depending on whether the colostomy is temporary or permanent. 
     One problem encountered in a colostomy is that the tissue on the surface of the colostomy spur 60 does not slide well against the fatty tissue defining the perimeter of the relatively small colostomy incision in the abdominal wall. The colostomy incision cannot be made too large or the patient suffers from paracolostomy herniation. Because the incision must be small, the surface of the colostomy spur is in intimate contact with the surface of the incision perimeter as the spur is pulled through the perimeter. 
     This creates a tissue traumatic situation which can result in postoperative internal bleeding and even in devitalization of the spur. These conditions require repetition of the operation and such repetition is considered a significant disaster by surgeons who perform this operation. 
     Accordingly, surgeons must delicately balance the problems encountered in making the colostomy incision too large on the one hand versus those of making the incision too small on the other. Surgeons have been living with these problems for many years and have relied on their experience to help them effectuate the required balance. 
     SUMMARY OF THE INVENTION 
     In the present invention, the surgeon eliminates the above problems by using a surgical method and device in which a flexible, sterile plastic sleeve is slipped over the end of the transected colostomy spur so that it extends from approximately the end of said spur a distance along the length thereof sufficient to allow the sleeve covered spur to be pulled through the relatively small colostomy incision with only said sleeve making contact with the perimeter of the incision. The sleeve is lubricated and the lubricated sleeve covered spur is then drawn through the relatively small incision such that the surface of the spur itself never comes into contact with the surface of the incision perimeter. When the spur has been pulled through the incision a distance satisfactory to the surgeon, the surgeon slides the sleeve the rest of the way through the incision and off over the end of the colostomy spur. 
     Preferably, the sleeve itself includes a notch extending from one end thereof to facilitate clamping the end of the colostomy spur closed with a clamp while simultaneously tying off the end by means of at least one suture affixed to the end of the sleeve above the base of the notch and above the level of the clamp. The sealing clamp can then be removed just before delivery of the spur through the relatively small incision in the abdominal wall. 
    
    
     As a result of the present invention, tissue trauma heretofore encountered during the drawing step is minimized and sterility of the procedure is increased by the presence of the sterile sleeve. These and other objects, advantages and features of the invention will be more fully understood and appreciated by reference to the written specification and appended drawings. 
     BRIEF DESCRIPTION OF THE DRAWINGS 
     FIG. 1 is a cross-sectional view of the abdominal cavity of the human body, taken on a plane through the small colostomy incision, with a colostomy being performed in accordance with prior art techniques; 
     FIG. 2 is an elevational view of the colostomy sleeve of the present invention being slipped over the end of the colostomy spur, and over the sealing clamp which is being used to seal that end; 
     FIG. 3 is an elevational view showing the clamp extending out through the notch in the end of the sleeve with the suture being tied above the level of the clamp; 
     FIG. 4 is a cross-sectional view of the abdominal cavity taken on a plane through the large, main incision with the sleeve enclosed colostomy spur in a condition such that it is about to be drawn through the relatively small colostomy incision; 
     FIG. 5 is a cross-sectional view of the abdominal wall at the small colostomy incision showing the sleeved colostomy spur after it has been drawn through the incision; and 
     FIG. 6 is the same cross-sectional view as FIG. 5 showing the colostomy sleeve after the sutures have been snipped, and as the sleeve is being pulled completely through the colostomy incision and off the end of the colostomy spur. 
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENT 
     In the preferred embodiment, the colostomy sleeve 10 of the present invention comprises a flexible, sterile plastic sleeve 10. The plastic employed must be flexible and must be sufficiently durable that it does not tear as the sleeve covered spur is being pulled through the colostomy incision. Also, the plastic must be a material which can be sterilized without deterioration. Finally, the plastic 10 should be transparent (at least after sterilization and prior to use) so that a surgeon can observe and assess the viability of the spur during all stages of the operation. I have found that nylon film of a thickness of approximately 1 mil is satisfactory. Portex Division of Smith Industries, Inc., Gill Street, Woburn, Mass. offers such a film on a roll, in sleeve form, for use in packaging sterilized instruments. They designate it as size 5, type B. 
     Sleeve 10 must be sufficiently large in diameter that it can readily be slipped over a clamp 70 being used to hold the end of spur 60 closed and over the spur itself with as little difficulty as possible (FIG. 2). It must be sufficiently long that when the spur 60 is pulled through the incision to the degree desired by the surgeon, only the surface of the flexible plastic sleeve 10 itself has come into contact with the surface of the perimeter of the colostomy incision 50. I have found approximately 12 inches to be a satisfactory length and about 2 inches when opened to a circular cross section to be a satisfactory diameter. Since spurs vary in length, the sleeve can be tailored during the operation. The 12 inch length insures sufficient length. 
     Preferably, flexible plastic sleeve 10 includes a notch 13 which extends from one end 11 of flexible sleeve 10 away therefrom a distance of about 11/2 inches to a base edge 15. The 11/2 inches are sufficiently long to allow one to, in essence, lay clamp 70 in notch 13 and tie a suture 16 around sleeve 10 and around the end of colostomy spur 60 at a point above the level of clamp 70 (FIG. 3). The width of notch 13 between its side edges 14 is sufficiently large to allow clamp 70 to lie therebetween. 
     Suture or tie 16 which is tied above clamp 70 is referred to as proximate suture 16 since it is closest to the notched end 11 of sleeve 10. It is sewn to sleeve 10 about its circumference in a conventional manner and at a point so that when tied, it is located above the base edge 15 of notch 13 a distance which is sufficient to allow clamp 70 to lie between base edge 15 and proximate suture 16. 
     A second suture or tie, referred to as a distal suture 17, is located on sleeve 10 at a point spaced from proximate suture 16 in a direction away from notch end 11. Distal suture 17 is also sewn onto sleeve 10 and is spaced from proximate suture 16 a distance which is large enough to allow clamp 70 to lie between the two sutures. Distal suture 17 does not need to overlie notch 13 and in fact preferably is located below the base edge 15 of notch 13 towards the opposite end 12 of sleeve 10. Distal suture 17 is necessary to insure that sleeve 10 does not slide off spur 60 during handling and therefore should be located farther from the end 11 of sleeve 10. 
     The term suture as used herein is not intended to be limited to any specific type of material. It is only important that the material be durable and sterilizable. In essence, the sutures or ties serve a clamping function. 
     The operational procedure begins the same as is conventional for colostomy. A large incision is made in the abdominal wall 21 so as to expose the interior of the abdominal cavity 20. The transection is performed and the rectum is sealed as is conventional. 
     The transected colostomy spur is sealed at its end by means of a sealing clamp 70 (FIG. 2). The surgeon slides sterile, flexible plastic sleeve 10 over clamp 70 and down over colostomy spur 60 (FIG. 2). 
     When the end of spur 60 comes approximately to the end 11 of flexible sleeve 10, clamp 70 is turned so that it extends laterally from spur 60 and from sleeve 10. Clamp 70 is also located so that it lies within notch 13 (FIG. 3). Proximate suture 16 is tied above clamp 70 and distal suture 17 is tied below clamp 70. Clamp 70 can then be removed and is removed just prior to delivery of the sleeve covered spur 60 to the small colostomy incision 50. Once sleeve 10 is in place on spur 60, it is lubricated by the surgeon, preferably simply employing fluids which are available within the abdominal cavity 20. 
     Then, colostomy incision 50, a relatively small incision, is made in the abdominal wall 21 at a point spaced from the main incision. Another clamp 80 is inserted through colostomy incision 51 and is used to grasp the sleeve covered end of colostomy spur 60 (FIG. 4). The sleeve covered spur 60 is drawn through incision 51 until it protrudes from incision 51 a distance satisfactory to the surgeon (FIG. 5). Usually this is about 2 or 3 inches. 
     The surgeon then snips the tied sutures 16 and 17 and slides flexible sleeve 10 upwardly through colostomy incision 51 and completely off the end of colostomy spur 60 (FIG. 6). This leaves the surface of spur 60 in intimate contact with the tissue defining the perimeter of incision 51. Since spur 60 does not have to be moved any further, there will be no trauma as a result of this contact. The operation is then completed in a conventional manner, with the spur 60 either being left in situ or matured, depending on whether or not the operation is to be a temporary or permanent colostomy. 
     Because flexible plastic sleeve 10 slides readily against the perimeter of incision 51, traumatic damage to both the surface of the perimeter of incision 51 and the surface of colostomy spur 60 is greatly reduced, if not almost entirely eliminated. Problems of devitalization are substantially eliminated. Further, the sleeve of the present invention enhances sterility of the operation by creating a colostomy tie-off to prevent spillage with resulting contamination of the abdominal cavity 20. Of course, it will be understood that the above is merely a preferred embodiment of the invention and that various changes and alterations can be made without departing from the spirit and broader aspects of the invention.