US2434030A - Sutureless method of rectosigmoid anastomosis and apparatus therefor - Google Patents

Description

Jan. 6, 1948. 'T. G. YEOMANS 4, SUTURELESS METHOD OF RECTO-SIGMOID ANASTOMOSIS AND APPARATUS THEREFOR Filed NOV. 13, 1945 3 advanced toward each other by means of the ballheaded, square-bodied tie bolt and its nut 6.

The cup member I is provided with a round clearance hole I, through which the tie-bolt 5 may pass freely, and a spherically formed ball seat 8 is marginally constituted about the hole I.

The cup member 2 is provided with a square clearance hole; I5 through which the square bodied tie bolt 5 is adapted to be passed freely.

Surrounding the square clearance hole I5 and in the lower end of the cup member 2 is a tapered socket I4, adapted to interchangeably receive body tubes II, of varying lengths, which are provided at one end with a tapered portion I3 which mates with the tapered socket I4 and is adapted to seat 4 string suture 2|, whipped over the cut edge of the bowel and tied around the tie-bolt.

The cup member 2 is then placed in the distal segment of the rectum with the body tube I I protruding from the anus, where it is held steady by an assistant.

A purse string suture 22 is then placed in the cut edge of the rectum. The cup member 2 and tube I I' are slipped over the tie bolt 5.

The rectal purse string 22 is then tied around the tie-bolt 5, the two segments of bowel are the tube I I in the socket I4 of the cup member 2.

The opposed, in-turn, annular flanges 3 and 4 of the respective cup members I and 2 have been found satisfactory for the desired clamping purpose when not less than one quarter inch in width and the inner edges I3 and I9, as well as the outer edges I6 and H, are best adapted for the purpose when provided with smoothly rounded corners of approximately one sixty-fourth inch radius.

The square bodied tie-bolt 5 is provided with an integral spherical head 20, and the portion 9 directly adjacent the ball is necked down to a round section for a short distance in order to permit equal ball and socket action of the ball in the socket 8 in all directions. The oppositeend of the tie-bolt 5 is provided with threads Ill adapted to engage the internal threads of the hand nut 5. The total length of the tie-bolt 5 is so related to the total length of the body tube II that when the apparatus is assembled, as shown in Fig, 1, clamping pressure may be exerted between the opposed faces of the annular flanges 3 and 4.

The hand nut 6 may be provided with coarsely fluted grooves to provide more secure gripping surfaces for the fingers,

While a number of metals may be used in the construction of the apparatus, aluminum has proven very satisfactory for the cup members, the body tube and the hand nuts, on account of its light Weight, while the tie-bolt is best made from Steel in order to secure sufflcient strength in a bolt of small diameter.

The maximum diameters of the cup members I and 2 must not be too small, lest the stoma be too narrow, nor should they be too large to remove through the anus, unless the sphincter is to be divided and later repaired.

One and one-half inches has been determined in use to be a median of satisfactory diameters.

The body tube l I must be selected of such length that it will project sufficiently beyond the anus to be grasped and held against turning by suitable shaped forceps or pliers, but not enough to be clumsy.

The entire apparatus must have all exterior surfaces smooth and highly polished, but such finish is not necessary on such concealed surfaces as do not contact the bowel.

The opposing faces of the flanges 3 and 4 may be perpendicular to the longitudinal axis as shown in Fig. 2, or they may be disposed angularly with respect to the longitudinal axis, as shown in Fig. 1, in order to facilitate their concentric axial alignment.

In practice of my method the operating surgeon, having severed the bowel and removed the section containing the neoplasm, places the cup member I upon the tie-bolt 5 and inserts it into the proximal bowel where it is secured by a purse brought together, with the square portion of tiebolt 5 entering and freely engaging the square clearance hole I5 and the threaded portion extending through and beyond the body tube I I.

With the cup members I and 2 manipulated into positions of approximate alignment, the assistant screws the hand nut down against the projecting end of the body tube I I, which he at the same time restrains from any tendency to turn, by means of shaped jaw forceps, and thereby clamps the inturned bowl walls between the opposing faces of the flanges 3 and l of the cup members I and 2.

The-tightening of the nut is continued until the clamped portions of thebowel walls are sufficiently thinned and compressed so that no blood is thereafter supplied to the clamped portions between the flanges.

The apparatus and the bowel in its then condition are as shown in Fig. 1, with the serous coats in goodcontact outside the clamped area, and union proceeds at once, occuring first by adherence of the serous coats in contact within approximately six hours and then extending across the muscular coats.

In due course, union will be entirely efiected and the tissues between the opposed clamping surfaces of the flanges 3 and 4, with all of that portion within the apparatus, will have become dead and have sloughed off and separated from the living tissues.

The apparatus may then, in its entirety. be lubricated and removed through the anus and, after its removal, the mucous membrane grows across the united junction and anastomosis of the colon to the lower rectum has been completed.

The operation is rapidly and safely performed without the use of sutures other than the temporary purse strings, which can be eliminated also by the use of any satisfactory internal, expanding clamp within the inner margins of the flanges,

The appearance of a section of the rectum after anastomosis, with thickened scar tissue, is shown in section in Fig. 3.

Having thus described my invention, I claim:

1. A clamp for recto-sigmoid anastomosis for temporarily retaining the inturned ends of both sections of a severed bowel and adapted to be inserted and removed through the anus, comprising in combination, an upper cup-shaped clamping member, a lower opposed cooperating cupshaped clamping member, each'of said clamping members being provided with inwardly extending opposed clamping flanges, a hollow body member, a tie rod extending through said hollow body member and said clamping members, one end of said tie rod extending beyond the hollow body member and manually operated means cooperating with said extending: end for drawing said clamps tightly together, substantially as and for the purposes set forth.

2. A clamp for recto-sigmoid anastomosi for temporarily retaining the inturned ends of both sections of a severed bowel and adapted to be member, the opposite end of said tie rod having 10 an external ball and socket connection with the upper clamping member, and manually operated means cooperating with said extending end for drawing said clamps tightly together, substantially as and for the purposes set forth.

THERON GROVER YEQMANS.

REFERENCES CITED The following references are of record in the file of this patent:

UNITED STATES PATENTS Name Date Bacon July 18, 1933 OTHER REFERENCES Ex parte Brinkerholf, vol. 24, Commissioners Manuscript Decisions, page 349.

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