RU-2861539-C1 - METHOD FOR CLOSING ANTERIOR ABDOMINAL WALL AFTER TRANSVERSE MINILAPAROTOMY DURING SURGERY FOR COLON CANCER

RU2861539C1RU 2861539 C1RU2861539 C1RU 2861539C1RU-2861539-C1

Abstract

FIELD: medicine; surgery; oncocoloproctology. SUBSTANCE: during surgery for colon cancer, a skin incision of the anterior abdominal wall of no more than 10 cm is made. The tissues are dissected layer-by-layer in the transverse direction to the rectus abdominis muscle. The rectus abdominis muscle is retracted medially. The posterior layer of the rectus abdominis sheath is incised transversely together with the peritoneum. A wound protector is installed in the wound and the gross specimen is removed. The posterior layer of the rectus abdominis sheath is sutured, performing the first needle insertion 5-8 mm from the medial angle of the wound towards the linea alba. The wound is closed with a continuous suture using the "small bites" technique - insertion 5-8 mm from the wound edge, with a step of 5-8 mm. The suturing of the posterior layer of the rectus abdominis sheath is completed and fixed with an Aberdeen knot at the point of transition of the suture to the external layer of the rectus abdominis sheath. The needle is passed from the inside out at a point located 5 mm lateral to the angle of the wound of the anterior layer of the rectus abdominis sheath. The anterior layer of the rectus abdominis sheath is sutured in the medial direction. The suture of the anterior layer of the rectus abdominis sheath is completed at a point located 5 mm from the medial angle of the wound towards the linea alba, fixed with an Aberdeen knot. The subcutaneous fat is debrided. The subcutaneous fat is closed with separate interrupted sutures with a step of 1 cm. EFFECT: closure of the anterior abdominal wall after transverse minilaparotomy during surgery for colon cancer, lower risk of postoperative complications, higher quality of life for patients with colon cancer. 6 cl, 1 tbl, 10 dwg, 3 ex

Inventors

KULUSHEV VADIM MARATOVICH
Sharenkova Anastasiia Sergeevna
Bagateliia Zurab Antonovich
Shabunin Aleksei Vasilevich
Grekov Dmitrii Nikolaevich
Lebedev Sergei Sergeevich
Titov Konstantin Sergeevich
Sokolov Nikolai Iurevich
Lebedko Maksim Sergeevich
Maksimkin Aleksandr Ivanovich

Dates

Publication Date: 20260505
Application Date: 20250522

Claims (5)

1. A method for suturing the anterior abdominal wall after transverse minilaparotomy during surgery for colon cancer, characterized by the fact that a skin incision of no more than 10 cm is made, the tissues are dissected layer by layer in the transverse direction to the rectus abdominis muscle, the rectus abdominis muscle is retracted medially, the posterior leaflet of the sheath of the rectus abdominis muscle is transversely dissected together with the peritoneum, a wound protector is installed in the wound and the macropreparation is removed, characterized in that the posterior leaflet of the sheath of the rectus abdominis muscle is stitched, performing the first puncture of the needle 5-8 mm from the medial corner of the wound towards the white line of the abdomen, then the wound is sutured with a continuous suture using the “small bytes” technique - a puncture from the edge of the wound 5-8 mm, with a step of 5-8 mm, finishing suturing the posterior leaflet of the sheath of the rectus abdominis muscle and fixing it with an Aberdeen knot at the place where the suture transitions to the outer leaflet rectus abdominis sheath, insert the needle from the inside out at a point 5 mm lateral to the wound angle of the anterior leaflet of the rectus abdominis sheath, suture the anterior leaflet of the rectus abdominis sheath in the medial direction; complete the suture of the anterior leaflet of the rectus abdominis sheath at a point 5 mm from the medial wound angle towards the linea alba, secure with an Aberdeen knot; sanitize the subcutaneous fat, suture the subcutaneous fat with separate interrupted sutures at 1 cm intervals.
2. The method according to paragraph 1, characterized in that the DEXTRUS wound protector is used as a wound protector.
3. The method according to paragraph 1, characterized in that after removing the macropreparation, the tissues are sutured layer by layer using a PDS 1/0 loop thread.
4. The method according to paragraph 1, characterized in that when suturing the anterior leaflet of the rectus abdominis sheath in a patient with poorly defined subcutaneous fat, the “pigtail” of the Aberdeen knot is additionally immersed by separate suturing.
5. The method according to paragraph 4, characterized in that the double thread is divided into single threads in the area of the needle and the sheath of the rectus abdominis muscle is stitched with fixation using 2-3 knots.

Description

The invention relates to medicine and surgery, specifically to oncocoloproctology. It can be used in healthcare to reduce the risk of postoperative complications in patients with colon cancer. Colorectal cancer is one of the leading oncological diseases in Russia and many other countries worldwide. According to GLOBOCAN 2022 data [1], obtained from an analysis of incidence and mortality from 36 malignant neoplasm sites in 185 countries, in 2022, 1,142,286 new cases of colorectal cancer were diagnosed globally in both sexes, accounting for approximately 10% of the total incidence of cancer in various sites [2]. In the structure of malignant neoplasm incidence in Russia in 2023, colorectal cancer ranked second in terms of the number of cases among men and women. The crude incidence rate of colon and rectal cancer in Russia in 2023 was 32.56 and 22.61 per 100,000 population, respectively [3]. To date, surgery remains the primary radical treatment for most forms of colorectal cancer [4]. With the development of laparoscopic and robotic-assisted technologies, they have become increasingly used in colorectal cancer surgery, as it is well known that minimally invasive interventions are associated with earlier patient mobilization, a lower incidence of wound complications, and postoperative ventral hernias [5]. The main stages of the operation during laparoscopic or robot-assisted colon resection are performed intracorporeally in the abdominal cavity, and the extraction of the resected macrospecimen can occur through organs communicating with the external environment, for example, through the vagina and rectum [6]. This technique is called "natural orifice specimen extraction surgery" (NOSES) [7]. Despite the obvious advantages of NOSES over laparotomy, such as the absence of an incision and wound complications, these techniques have limitations and disadvantages [6,8]. For example, the transvaginal technique for specimen extraction is only available for women, and vaginal incision is associated with sexual dysfunction [9], while opening the rectal lumen can lead to bacterial contamination of the abdominal cavity and potentially increase the risk of infectious complications [10-14]. When removal of a macroscopic specimen from the abdominal cavity through natural openings is not possible, additional access must be achieved through the abdominal wall. The following mini-approaches are described in the literature: longitudinal mini-laparotomy along the midline (upper, middle, lower midline laparotomy), transverse lateral incisions, and the Pfannenstiel approach [9,15]. The most popular are longitudinal mini-approaches through the white line of the abdomen, as they are technically simpler to perform. However, the use of longitudinal incisions is often associated with the development of postoperative ventral hernia [16-18], which leads to a decrease in the patient's quality of life, possible strangulation of the hernia, and the development of peritonitis, sepsis, and other life-threatening conditions. The steady increase in colorectal cancer incidence and early diagnosis facilitate the identification of resectable forms of the disease, which, in turn, increases the number of minimally invasive surgical interventions. Research into risk factors and the search for mini-approaches that can reduce the incidence of wound complications and postoperative ventral hernias remain relevant. The proposed method is easy to use, does not require advanced training of physicians for its practical application and does not incur large financial costs, and also provides a more favorable prognosis for patients with colon cancer compared to existing longitudinal minilaparotomy methods. The method we developed for suturing the anterior abdominal wall after transverse minilaparotomy during colon cancer surgery turned out to be more effective and safer than existing ones. The essence of the proposed invention is explained by the following graphic materials: Fig. 1 – Scheme of distribution of patients depending on the types of incisions used for extraction of the macropreparation; Fig. 2 – Stage of performing transverse access, where 1 is the anterior leaflet of the rectus abdominis sheath, 3 is the rectus abdominis muscle; Fig. 3 – Stage of performing transverse access, where 1 is the anterior leaflet of the rectus abdominis sheath, 3 is the rectus abdominis muscle; Fig. 4 – Stage of performing the transverse approach, where 1 is the anterior leaflet of the rectus abdominis sheath, 3 is the rectus abdominis muscle; Fig. 5 – Stage of performing the transverse approach, where 1 is the anterior leaflet of the rectus abdominis sheath, 2 is the posterior leaflet of the rectus abdominis sheath, 3 is the rectus abdominis muscle; Fig. 6 – Stage of suturing the transverse incision; Fig. 7 – Stage of suturing the transverse incision; Fig. 8 – Stage of suturing the transverse incision; Fig. 9 – Stage of suturing the transverse incision; Fig. 10 – Graphic