US 3144868 A
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Description (OCR text may contain errors)
Aug. 18, 1964 M. E. JASCALEVICH DRAINAGE AND FEEDING CANNULAE Filed Oct. 21, 1960 INVENTOR MARK) E. JASCALEVICH ATTORNEY UCTIDN United States Patent 3,144,868 DRAINAGE AND FEEDING CANNULAE Mario E. Jascalevich, 435 60th St., Weehawiren, NJ. Filed Oct. 21, 1960, Ser. No. 64,088 4 Claims. (Cl. 128350) The invention relates to improvements in surgical devices of the type suitable for post-operative treatment of portions of the gastro-intestinal tract.
Treatment following certain types of gastrointestinal surgery requires that both aspiration and feeding be accomplished at affected areas. Aspiration serves to remove excess or undesirable fluids; the supply of nutritive fluids is necessary to provide nourishment and promote healing. It has been proposed to utilize the nasal route for drainage and feeding. Nasogastric intubation however, has resulted in the development of lesions of the upper respiratory and digestive tracts, producing ulcerative and later stenosing esophagitis. Moreover, many individuals, because of age, emotional make-up or otherwise, cannot tolerate nasogastric intubation. As a result, and to obviate the problems and disadvantages attending nasogastr-ic intubation, the more usual technique resorted to in recent years has been a temporary gastrostomy.
A known technique for a gastrostomy, more particularly a gastrectomy, involves the use of a device comprising a double-lumen tube in the form of a single body or unit through which suction and feeding take place. The lumens are disposed in fixed, side-by-side relation throughout their lengths. Where, as in a Billroth II, the application of suction to drain is necessary in the gastric or aiferent loop, coupled with feeding to the eiferent loop, it is impossible to aspirate the one area and feed the other with the aforementioned prior art device. Also, in the first week following a gastroenterostomy, it is imperative that the afferent loop be kept clean and empty, and obstruction or kinking of the loop must be prevented. At the same time, nutritive fluid must be independently supplied at another and differently located area; namely, the efferent loop.
In accordance with the invention, a device suitable for temporary gastrostomy is provided which permits aspiration and jejunal feeding to be accomplished simultaneously at the spaced areas where respective suction and feeding are required. The nasal route is avoided. Independent suction from the stomach and/ or the afferent anastomotic loop is coupled with the injection of feeding solution into the efferent loop. The device is particularly adapted for use in connection with a Billroth II and a gastroenterostomy. The afferent loop, which is particularly prone to obstruction, is prevented from being obstructed. The device of the invention, by permitting gastric suction and intra-duodenal feeding to be accomplished simultaneously and at the separate areas which selectively require independent suction and feeding, is also suitable for use in connection with a Billroth I and an esophago-gastric resection.
These, and other advantages of the invention will be apparent from the following description of a preferred embodiment of the invention, taken in conjunction with the drawing, in which:
FIG. 1 is a side elevational view, partly broken away and in section, of a device made in accordance with the invention;
FIG. 2 is a diagrammatic view showing the device of the invention employed in a Billroth II; and
FIG. 3 is a diagrammatic view showing the device of the invention as employed in a gastroenterostomy.
Generally, a surgical device made in accordance with the invention, comprises a drainage conduit and a separate feeding conduit. The conduits or tubes, which are of flexible, resilient material, are maintained in adjoining, parallel relationship along the upper portions of their lengths. The upper ends of the conduits are adapted for respective connection to a suitable suction means and a source of food supply. The lower portions of the con-- duits are unconfined or free to provide separate limbswhich are laterally movable for independent positioning in selected areas. Such relationship of the conduits permits the freely movable limb portion of the drainage conduit to be positioned in the afferent loop so that suction may be applied to such area to keep it clean, while permitting the freely movable limb portion of the feeding conduit to be positioned in the efferent loop for the supply of nutritive fluid thereto. The presence in the afferent loop of the section of flexible, resilient tubing having a tendency to straighten out to its normally linear position serves to prevent undesirable kinking or obstruction of the loop in which such section or limb of the drainage conduit is located.
In greater detail, and referring to FIG. 1 which illustrates a preferred embodiment of the invention, an elongate, tubular body 10 is provided for the support of a drainage conduit or tube 12 and a feeding conduit or tube 14. The tubes 12 and 14 are of smaller diameter than the tubular body 10. In fact, the total diameter of both the drainage and feeding tubes is somewhat less than the internal diameter of the tubular body within which they are disposed and supported. The tubular support body 10 and the drainage and feeding tubes 12 and 14 are preferably of elastomeric material, such as surgical-grade rubber.
The drainage and feeding tubes extend and are maintained generally parallel to one another for the portions of their lengths within the tubular body. The upper end of the drainage tube 12 is in communication with the exterior of the tubular body. Similarly, the upper end of the feeding tube 14 is in communication with the exterior of the tubular body. As shown, the uppers ends of the drainage and feeding tubes are provided with obliquely offset portions 16 and 18, respectively, which extend through openings 20 and 22 formed in the wall of the tubular body. Preferably, and as illustrated, the obliquely offset portions are formed to provide increased diameters to facilitate respective connection of the tubes to sources of suction and food supply. The flared diameters also assist in providing a suitable seal at the openings 20 and 22 in the body wall, fitting snugly in the openings where the tube portions extend through the wall. To identify the tubes for the user of the device, the exposed ends may be imprinted with a suitable legend as indicated on FIG. 1.
The drainage and feeding tubes 12 and 14, while confined adjacent one another for the portions of their lengths within the tubular body 10, extend downwardly and exteriorly of the tubular body, passing out of the tubular body through an opening 24. From a viewing of FIG. 1, it will be apparent that the portions of the drainage and feeding tubes, designated 12a and 14a, respectively, which extend exteriorly beyond the lower end of the tubular body are not connected to one another or confined, so that they are free for independent, lateral movement with respect to one another. Accordingly, the tube portions or limbs 12a and 14a can be independently positioned at respective, desired areas of treatment.
The drainage or aspirating tube 12 is provided along its free, unconfined limb portion 12a with a series of spaced inlet apertures 26. The limb portion Ma is provided at its distal end with a discharge aperture 28. If desired, a second discharge aperture may be provided inwardly of the distal end.
In order to assist in holding the device in position, an
inflatable annulus or balloon 30 is provided adjacent the juncture of the free, lower limb portions 12a and 14a and their confined upper portions. As shown in FIG. 1, the inflatable balloon preferably comprises an annular band of thin, elastic material which is formed to extend in spaced, surrounding relationship with respect to the lower end of the tubular body 10. The thin, annular band is preferably formed with the edges thereof molded integrally with the wall of the tubular body. A longitudinally extending conduit 32 is related to the thin, annular band to permit a fluid to be conveyed to the area between the band and the adjoining wall of the tubular body to inflate the band or balloon. As shown, the wall of conduit 32 is molded integrally with the wall of the tubular body for most of its length, and has an outlet 34 to the inflatable balloon 3E The opposite end of the conduit 32 is in communication with a nipple-like extension 36 of the body 10, and has an opening at its end 38 for connection to a suitable fluid source applied under pressure, and inflation of the balloon. preferably provided with a bend 40 to facilitate tying off the extension after the pressure source has been removed, thereby maintaining the annular band or balloon in inflated condition; The extension 36 may be molded integrally with the tubular body or, as shown, the extension may be made as a separate piece and cemented to the tubular body at 42.
The device of the invention is used in the following manner. After a gastrostomy has been performed by the usual technique, the drainage tube limb 12a is passed into the segment of the bowel where suction is desired; that is, the stomach, duodenum or afferent loop, as the case may be. The feeding limb 14a is introduced in the duodenum or the efferent loop, depending on the situation. The distal or lower end of the tubular body 10 is then passed inside the stomach, and the balloon is inflated. The gastrostomy is completed, as with a Stamm technique, while the proximal end of the tubular body 10, including the flared portions 16, 18 and the portion 36, is positioned outside of the abdomen. With the drainage tube end 16 connected to a suitable source of suction, such as a Wangesteen machine, and the feeding tube end 18 is connected to a suitable drip feeding device, the device is suitably fixed to the skin edge of the incision. If desired or necessary, the aspirated fluids can be injected through the feeding tube after being aseptically collected.
FIG. 2 shows the device of the invention as employed in connection with a Billroth II. The limb 12a of the drainage conduit is positioned to apply suction in the afferent loop, and the limb 14a is positioned in the efferent loop to supply nutritive fluid thereto.
FIG. 3 shows the use of the device as employed with a gastroenterostomy in connection with which the drainage limb 12a is similarly positioned for gastric afferent loop suction, and the limb 14a is positioned to supply nutritive fluid to the efferent loop.
The afferent loop has a tendency to kink and thereby become obstructed. The resilient limb 12a, in addition to removing fluid from such area, and because of its tendency to return to its normal straight or linear condition, acts to prevent such kinking.
While the device of the invention is particularly effective in connection with a Billroth II gastrectomy, and when used after a gastroenterostomy, the device is also suitable to furnish gastric suction and intraduodenal feeding for a Billroth I and a gastro-esophago resection.
While a preferred embodiment of the invention has been illustrated and described, it will be apparent that various modifications and changes may be made. For example, while the drainage and feeding conduits have been shown as single, continuous, separate tubes, it is within the scope of the invention to have these tubes confined within the tubular body and extending below the lower end of the The extension 36 is tubular body no further than to provide separate nipples. Whereupon, separate tube sections or limbs of a length required by the exigencies of the individual case may be secured to such nipples. It will be understood that this, and other modifications and changes may be made without departing from the spirit and scope of the invention as sought to be defined in the following claims.
1. A device suitable for use in connection with a gastrostomy comprising a flexible drainage conduit of elastomeric material, a flexible feeding conduit of elastomeric material, means for maintaining said conduits adjoining one another and in parallelism along the upper portions of their lengths, the upper ends of said conduits being adapted for respective connection to suction means and a source of food supply, the lower portions of said conduits being free for independent positioning in selected areas, an inflatable balloon, means for maintaining said balloon adjacent the juncture of said upper and lower portions of the drainage and feeding conduits and surrounding the conduits, and a third flexible conduit of elastomeric material associated with and maintained substantially parallel to said drainage and feeding conduits in communication with said inflatable balloon.
2. A device suitable for use in connection with a gastrostomy comprising a flexible tubular body, a flexible.
drainage tube within said body, a flexible feeding tube within said body, the upper ends of said tubes being in communication with the exterior of said body for respective connection to suction means and a source of food supply, a flexible conduit within said body having the upper end thereof in communication with the exterior of said body, an inflatable balloon, means for maintaining said balloon adjacent to and surrounding the lower end of said body, the lower end of said conduit being in communication with said inflatable balloon, said drainage and feeding tubes each being of a length to extend exteriorly beyond the lower end of said body for free independent positioning in selected areas.
3. A device suitable for use in connection with a gastrostomy comprising a flexible tubular body, a flexible drainage tube within said body, a flexible feeding tube within said body, the upper ends of said tubes being in communication with the exterior of said body for respective connection to suctionmeans and a source of food supply, a flexible conduit within said body and formed integrally therewith, an inflatable balloon, the upper end of the conduit being in communication with the exterior of said body and the lower end of said conduit being in communication with said inflatable balloon provided adjacent the lower end of said body, said balloon being formed integrally with said body, said drainage and feeding tubes each being of a length to extend exteriorly beyond the lower end of said body for free independent positioning in selected areas.
4. A device as set forth in claim 3, wherein the tubular body, the drainage tube, the feeding tube, the conduit and the inflatable balloon are of elastomeric material.
References Cited in the file of this patent UNITED STATES PATENTS 617,016 Harris Jan. 3, 1899 2,587,910 Shulman Mar. 4, 1952 2,831,487 Tafilaw Apr. 22, 1958 2,936,760 Gants May 17, 1960 FOREIGN PATENTS 758,357 France Jan. 15, 1934 OTHER REFERENCES J.A.M.A., vol. 158, No. 15, Aug. 13, 1955, A New Technique Combining Suction and Feeding for Use in Gastric Surgery, page 1361 required.