Technical Aspects of Invaginacionnoj Appendectomy

Introduction In the 10th century were developed the basic principles of surgical treatment of acute appendicitis. Much of the credit for this matter belongs Koheru, Mar-Burneju, Volkovichu, Djakonovu and other surgeons. Were developed by the operational access to the tree, techniques appendectomy and drainage of the abdominal cavity. Special attention was given to the technique of peritonizacii the stump of this body. Their ways suggested Fowler, Lexer, Rostovtsev, rusanov and other surgeons [1]. All authors in his writings reflect the importance of the peritonizacii stump vermiform process by dipping it into the lumen of the cecum through overlay kisetnogo and Z-shaped seams [1-3]. However, it does not dive into the lumen of the gut and immurement stump in a Pocket formed by the serous shell. This sometimes led to the formation of abscesses and faecal fistulae in the right iliac region, because submerged fragments of inflamed tissue. Virtually every appendectomy ended development of an immured in a zone mikroabscessa stump, which is then opened with enough clearance in the cecum. For this reason, the development of a method that would provide true dive Appendix stump clearance in the cecum, deserves attention.


Introduction
In the 10 th century were developed the basic principles of surgical treatment of acute appendicitis. Much of the credit for this matter belongs Koheru, Mar-Burneju, Volkovichu, Djakonovu and other surgeons. Were developed by the operational access to the tree, techniques appendectomy and drainage of the abdominal cavity. Special attention was given to the technique of peritonizacii the stump of this body. Their ways suggested Fowler, Lexer, Rostovtsev, rusanov and other surgeons [1]. All authors in his writings reflect the importance of the peritonizacii stump vermiform process by dipping it into the lumen of the cecum through overlay kisetnogo and Z-shaped seams [1][2][3]. However, it does not dive into the lumen of the gut and immurement stump in a Pocket formed by the serous shell. This sometimes led to the formation of abscesses and faecal fistulae in the right iliac region, because submerged fragments of inflamed tissue. Virtually every appendectomy ended development of an immured in a zone mikroabscessa stump, which is then opened with enough clearance in the cecum. For this reason, the development of a method that would provide true dive Appendix stump clearance in the cecum, deserves attention.

Materials and Methods
Among 105 patients with acute appendicitis, of whom 58 (55.3%) It was kataralno and 47 (44.7%) flegmonoznoe inflammation, after implementation of the appendectomy Stump Sprouts was submerged in the lumen of the cecum as follows [4][5][6]. After bandag-ing and clipping bryzhejki vermiform process is pulled up. At a distance of 1.0-1.5cm from the top of the resulting Cone (the base of the vermiform process) are superimposed two serous polukisetnyh seam (from the inside of the outer side of it), that perform another role derzhalok. Based on the process of the serosa circularly nadsekaetsja and vyvorachivajas inside out mucous to exfoliate from the polukisetnyh line of stitches.
Following this process stretches and naked the mucous membrane of the cecum is superimposed a thin nylon or rayon circular ligature. (Figure 1) provides an illustration of the execution phase of the operation, where 1 is a vermiform process, 2-3, the cecum is the serosa, 4-5, mucosa-Ligature on the mucous membrane, 6 strand polukisetnogo (Figure 2). Not reducing the tension of the tissue above the ligature superimposed clip and beneath it is dissected linking plot of the mucous membrane of the founding of the vermiform process. As soon as it happened, stretched mucosa cecum along with the node is shifting toward its clearance. Inverted inside out the edges of the serous shell shifted inwards, polukisetnye joints are tightened, resulting in peritonizacii of injured tissues.

Resultants and Discussion
All 105 patients complications during and in the immediate postopera-tive period was not observed. Surgical technique easily doable. Comes true invaginacija mucous membranes of the transition zone between the base process and blind gut, the lumen of the intestine. The risk of mikroabscessov in invaginirovannyh area of tissue decreases. It creates the conditions for the exclusion of traumatized tissue in the lumen of the gut, which is important in the prevention of postoperative purulent complications.

Conclusion
The proposed methodology is somewhat different from appendectomy existing. It helps reduce the risk of development of purulent complications in the field performed appendecto-my. It can be used during laparoscopic appendectomy.

Annotation
The author describes the technique of dive invaginacionnogo stump vermiform process clearance in the cecum. The method was applied at 105 patients suffering acute appendicitis of whom 58 (55.3%) It was kataralnoe and 47 (44.7%) flegmonoznoe inflammations. Complications were observed.