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A. Doyen's intestinal occlusion clamps:
This instrument has finger bows, a pair of shaft with a pair of long blades. The blades are lighter and there are vertical serrations in the blade. There is a rachet, which when closed bring the blades in apposition. This instrument may be curved or staright.B. Carwardine's twin intestinal occlusion clamps: This is a paired instrument. These are smaller, lighter instrument than Doyen's intestinal occlusion clamps. In addition to finger bows, rachet and a pair of shaft and blades, there is a slot on the side of one instrument and a screw on the shaft of the other instrument. when applied properly the slot and the screw fits and this keeps this instrument side by side, so that the intestinal loops are kept side by side during anastomosis.uses:These instruments are used for gut resection and anastomosis.
What are the indications of intestinal resection and anastomosis?
Strangulated hernia with devitalisation of gut.
Intestinal obstruction with strangulation/ intestinal trauma causing devitalisation of a segment of gut.
Intussusception which is irreducible or has caused strangulation of a segment of gut.
Intestinal neoplasm.
Meckel's diverticulum requires excision with a wedge of ileum.
Crohn's disease with stricture or fistula.
Ulcerative colitis not responding to medical treatment.
Intestinal tuberculosis with stricture formation.
What are the different techniques of intestinal anastomosis?Standard two layer anastomosis: Consisting of-
Inner layer of suture taking the full thickness of the bowel wall- Posterior and anterior through and through layers.
Outer seromuscular layer- Posterior and anterior seromuscular layers.
Single layer anastomosis: There are different techniques of applying single layer suture.
Simple interrupted surure through the full thickness of the intestine with knot placed towards the mucosal aspect.
Gambee stitch- Suture passed through all layers of the intestine with a loop on mucosa on each side of the anastomosis for better mucosal inversion.
A single layer extramucosal stitch- Suture passed from the serosal aspect and emerges through the submucosa and making a loop on submucosa on each side of the anastomosis.
Which suture material will you prefer for intestinal anastomosis?
In two layer anastomosis: Posterior through and through and anterior through and through with absorbable suture- Polyglactin (Vicryl), Polydioxanone (PDS), Polyglecaprone (Monocryl) or catgut.
Posterior seromuscular and anterior seromuscular with Mersilk, Polyglactin or Polydioxanone suture.
In single layer anastomosis either mersilk or Polyglactin sutures are used.
The size of the suture material for gut anastomosis is 2-0 or 3-0.
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