WO1993025149A1

WO1993025149A1 - Bilio-digestive anastomosis device requiring no circular suture of the bile duct

Info

Publication number: WO1993025149A1
Application number: PCT/FR1993/000506
Authority: WO
Inventors: Jacques René VAILLANT
Original assignee: Vaillant Jacques Rene
Priority date: 1992-06-12
Filing date: 1993-05-25
Publication date: 1993-12-23
Also published as: FR2692135A1; FR2692135B1

Abstract

A device for performing bilio-digestive anastomosis without circularly suturing the end of a long, thin bile duct. The device consists of pegs (1) with a channel (2), a cylindrical body (3) with a vertical slot (4) and three circular grooves (5), a tapered lower end (6), locking members (7) closed over a central opening (9) by a clasp (8) to grip the channel (2) of a peg, a frame (10) with two arms (11) hinged together by two lugs and two screws (12), adjusted by means of two nuts (13) and held apart by two springs (14). When the device is in place, the end of the tract may be separated into two short valves which may be attached, in an inverted T arrangement, to the rear surface of a Y-shaped gut loop portion, without suturing the mouth portion, and therefore without causing wound healing activity. Said device is particularly suitable for restoring the continuity of the tract during liver transplants, some duodenal-pancreatic excisions and secondary refections of the long bile ducts.

Description

Device for bilio-digestive anastomosis without circular suturing on the main channel

The present invention relates to a device for restoring bile continuity after a low section of fine main channel.

The sections of the main channel are conventionally repaired by end-to-end suturing of the canal ends or by implantation in an intestinal loop and the uncontrollable scarring of these fine circular sutures exposes them, for years, to the risk of stenosis.

The device according to the invention makes it possible to separate the termination of the canal into two short valves and then to fix them, in inverted T, on the posterior face of a Y-shaped loop, without suturing - therefore without scar activity - at the level of the mouth. .

The accompanying drawings illustrate the invention:

- the 1/3 plate represents the device, ^• - the 2/3 plate its installation,

- the board 3/3 its use.

With reference to these drawings, the device comprises:

1) Anchors (1) whose diameters correspond to the different sizes of the main track. They present:

• An upper end with a circular groove (2).

• A cylindrical body (3) with:

- a vertical slit (4) in the middle in which a scalpel blade can slide and the upper end of which does not reach the lower edge of the groove (2);

- three circular grooves (5) at 1, 1, 5 and 2 centimeters below the groove (2).

• A tapered lower end (6) with a foam tip.

2) Keys (7) with two articulated branches with a bevelling chamfer, the closure of which, held by a bolt (8), provides a medial orifice (9) for retaining the groove (2) of an ankle without tightening and securing it the two pieces perpendicularly. Several keys of different sizes can be closed on the same ankle.

3) A frame (10) whose two horizontal branches (1 1) are spaced in the middle for the passage of a dowel (1) and are articulated at their ends by two lugs and two screws (1 2) adjustable the request by two threaded and knurled nuts (1 3). The open frame extends beyond the surface of the key. Its progressive screwing brings its two branches below it. It is held in the open position by two springs (14) interposed between its two branches (1 1) and crossed by the two screws (12).

According to variants not illustrated, your ankles (1) can be more or less long and curved, have more circular grooves (5), the keys have inclined branches, in the form of a circumflex accent ...

REPLACEMENT SHEET These variants, given by way of example, do not limit the field of the invention from which one would not depart by replacing the execution details with any other equivalent. The three products can be made of stainless steel or any other material.

The use of the device includes 4 successive times. An ankle (1) and a key

(2) are initially arranged on the main track. An intestinal loop is then prepared before the installation of the device which makes it possible to perform the anastomosis.

1) The main line is sectioned at the upper edge of the duodenum without underlying dissection. The dowel (1) corresponding to its size is fixed on its lower edge by a thread passed through the slot (4) of the dowel and knotted laterally in one of the grooves (5) of the body (3) of the dowel. Preferably, the second, 1.5 cm below the throat (2) of the ankle. The longest key (7), depending on the exposure possibilities, is closed on the groove (2) of the ankle and held by its lock (8). Anchors 4 to 7 millimeters in diameter and keys 3 and 4 centimeters long by 0.6 to 0.8 centimeters wide were the most used during anatomical research.

2) A long Y handle is prepared. Its anterior wall is incised, at the union of its upper 2/3 and its lower 1/3, on 6 to 7 centimeters from its end which has not been closed. 3) The open handle, spread out, is presented on the point (6) of the ankle, in the middle of its serous face then it is mounted perpendicular to the ankle which pierces it and leaves the handle until the key (7) protrudes under the digestive wall. A plastic catheter inserted into the tip (6) of the ankle allows it to be slightly stretched while the other hand slides the digestive wall between thumb and index finger.

The frame (10) is placed on the relief of the key (7) then closed below it ensuring a firm grip and good exposure of the biliary termination on a flat and stable digestive surface. 4) A scalpel blade is slid into the slot (4) in the ankle and separates the two valves. The incision, limited in height by the ankle cleft, respects a short bile segment below the digestive wall (≠≠ 2 mm). The valves are fixed by two overlockings, anterior and posterior, of fine, smooth wire, set with two needles. The first point of each suture is passed transversely into the bile wall above the valve incision. The two needles then cross vertically the contiguous digestive wall, from inside to outside, then lead the slightly taut overlock from the origin to the end of the lateral edge of each valve where it is stopped. The valves are taken from the inside in order to flare them on the digestive wall. The suture is completed with a few separate stitches on their distal edge.

The frame is removed. The unlocked key releases the ankle. The handle is sutured. A radiological control is carried out by the cystic.

The use of the device makes it possible to perform a bilio-digestive anastomosis:

- solid, on a suture line longer than that of an orifice suture (3 times more for two valves of one centimeter) and more resistant,

- permeable, with full-channel opening of the main track in the loop, - whose watertightness, ensured without gaps by the two overhangs, dispenses with intra-canal drainage and tolerates radiological checks and leak-free pressure moldings,

- and above all, without scar activity in the mouth.

The device according to the invention is intended for the indications of this anastomosis which relate to the deliberate low sections of the liver transplants, of certain duodeno-pancreatectomies and the secondary repairs of long main tracks, after accidental section or traumatic rupture, to avoid the greater risks. stenosis to which fine gauge circular sutures are exposed on altered or infected canal ends. Its use could also be envisaged for implanting another fine channel in a cavity. For example, a ureter in a bladder, recalling that the principle of anastomosis was described, among other things, during the first attempts at ureterocystoneostomy.

Claims

1) Device for performing an end-to-side bilio-digestive anastomosis without circular suturing on the lower end of a long main channel of fine gauge. And to implant any other thin channel in a cavity.

Device characterized in that it comprises a dowel (1), a key (2) and a frame (10) whose arrangement makes it possible to separate the termination of the channel into two short valves and then to fix them, in inverted T, on the posterior surface of a Y-shaped handle, without suturing - therefore without scar activity - at the level of the mouth.

2) Device according to claim 1 characterized in that the dowels (1) have diameters which correspond to the different sizes of the main track and have:

• An upper end with a circular groove (2).

• A cylindrical body (3) with

- a vertical vertical slit (4) in which a scalpel blade can slide and the upper end of which does not reach the lower edge of the groove (2),

- three circular grooves (5) at 1, 1, 5 and 2 centimeters below the groove (2).

• A tapered lower end (6) with a foam tip.

3) Device according to claim 1 characterized in that the keys (7) have two articulated branches whose closure, held by a latch (8), provides an orifice (9) median to retain the groove (2) of an ankle without tightening it and securing the two parts perpendicularly. Several keys of different sizes can be closed on the same ankle.

4) Device according to claim 1 characterized in that the frame (10) has two horizontal branches (1 1) spaced in their middle for the passage of a dowel (1) and articulated at their ends by two lugs and two screws ( 12) adjustable on request by two threaded and knurled nuts (13). The open frame extends beyond the surface of the key. Its progressive screwing brings its branches below it. It is held in the open position by two springs (14) interposed between its branches and crossed by the two screws (12).