Orogastric catheter for longitudinal gastrectomy

Abstract

The invention relates to an orogastric catheter for a longitudinal gastrectomy. The object of the invention is to make available an orogastric catheter that represents an advantageous alternative to the poorly suited catheters used today and that facilitates the work of the surgeon. This novel orogastric catheter is characterized in that this distal part carries a balloon ( 25 ) which, in the inflated state, has a shape substantially matching that of the pyloric antrum ( 4 ), in such a way as to be able to be lodged in this pyloric antrum ( 4 ), the end of the inflated balloon ( 25 ) then being in abutment against the pylorus ( 5 ), and the distal end of the body of the catheter ( 20 ) for its part being in abutment against the pyloric antrum ( 4 ), while the part of the body ( 21 ) of the catheter ( 20 ) arranged above the inflated balloon ( 25 ) is wedged against the wall of the lesser curvature ( 6 ) of the stomach ( 1 ), thus making it possible to determine the position of the start of the closure resection line in the area of the pyloric antrum ( 4 ), to define the closure resection line, and to calibrate the pyloric antrum ( 4 ) and the gastric sleeve to be preserved.

1 . A method for standardizing calibration of pyloric antrum during a longitudinal gastrectomy comprising use of an orogastric catheter with a body whose distal part is used in bariatric surgical technique of longitudinal gastrectomy, to guide a surgeon for resection of a part of a stomach and to define a closure line after resection, wherein the body extends between a proximal end and a distal end, and presents an outer face and a distal part close to the distal end,
 characterized in that wherein said distal part carries a balloon having a deflated state and an inflated state,   wherein the balloon extends transversally from the outer face of the body and exclusively at one side of the body at a minimum distance d from the distal end of the body,   wherein in the inflated state, the balloon has a shape substantially matching that of a pyloric antrum of the stomach, the inflated balloon having a truncated conical shape that is asymmetric, the balloon having a base attached to the body, an end opposite the base and a middle part between said base and said end, the balloon being distorted with a terminal diameter Dt at the end of the balloon, a diameter Db at the base of the balloon and a diameter Dm of the middle part of the balloon, with Dt<Db≤Dm; the end being offset relative to an axis of the base of the balloon, upwards towards a part of the body of the catheter arranged above the inflated balloon, so that an upper face of the inflated balloon directed towards the proximal end of the body and when arranged opposite an angular notch of the stomach, has a less pronounced curvature than that of a lower face of the inflated balloon directed towards the distal end of the body, lodging and inflating the balloon in said pyloric antrum with the end of the inflated balloon being in abutment against the pylorus and the distal end of the body of the catheter being in abutment against the pyloric antrum, and a part of the body of the catheter arranged above the inflated balloon being wedged against a wall of the lesser curvature of the stomach, and thus permitting:   determining position for starting the resection line about the pyloric antrum,   defining the resection closure line,   and calibrating the pyloric antrum and a gastric sleeve to be preserved.   
     
     
         2 . A method according to  claim 1 , that includes using the inflated balloon dimensions in cross-section to determine a volume of the pyloric antrum preserved after resection and wherein the body dimensions in cross-section are used to determine a volume of stomach preserved after resection. 
     
     
         3 . A method according to  claim 1 , wherein the inflated balloon is conformed so that an upper face of the inflated balloon arranged opposite the angular notch of the stomach makes, with the body of the catheter, an angle α between 70 and 110°, preferably between 80 and 100°, and even more preferably of about 90°. 
     
     
         4 . A method according to  claim 1 , wherein the balloon is inflated with the distance d between the distal end of the body of the catheter and a point of the base of the inflated balloon closest to said distal end, is less than or equal to 30 mm, preferably less than or equal to 20 mm, and even more preferably is between 1 and 15 mm. 
     
     
         5 . A method according to  claim 1 , wherein the body is provided with a reference mark and the surgeon uses the marks to position the balloon correctly in the patient's stomach, so that once inflated, the balloon is lodged in abutment in the pyloric antrum, said reference mark preferably comprising a mark coaxial to the body and arranged on some or all of a length, advantageously the entire length, of a wall of the body, on a same side as the balloon. 
     
     
         6 . A method according to  claim 1 , comprising using a tube connecting the balloon to the proximal end of the body and using an inflating device for inflation/deflation of said balloon from this proximal end through the tube. 
     
     
         7 . A method according to  claim 1 , comprising providing:
 a tubular body of silicone with a length between 600 and 1200 mm, preferably between 700 and 1100 mm, and even more preferably between 850 and 950 mm and with an outside diameter De between 8 mm and 25 mm, and preferably between 10 mm and 13.33 mm, said body also being provided in its distal part with a rounded distal tip and lateral holes that provide communication between an interior of the stomach and an exterior of an alimentary canal via a lumen of the tubular body;   an inflated balloon with a diameter at the base Db between 35 and 60 mm and with a height H of 50 +/−10 mm, preferably +/−5 mm, and even more preferably +/−3 mm;   a positioning reference mark formed by a contrasting mark on the entire length of a wall of the body, on a same side as the balloon, in a diametrical plane common to the body and to the balloon;   and optionally means for deflecting the distal part of the catheter.   
     
     
         8 . A method according to  claim 8 , wherein the tubular body and the balloon are sized so that H+De=50 to 100 mm, even better 60 to 80 mm. 
     
     
         9 . A method according to  claim 1 , where the catheter:
 i. is introduced in patient's mouth until its distal end reaches patient's stomach,   ii. is used to extract fluids from the stomach;   iii. is lodged it in the pyloric antrum in such a way that the end of the inflated balloon is in abutment against the pylorus, that the distal end of the body of the catheter is in abutment against the pyloric antrum, preferably at a distance from 5 to 10 cm, even better 6 to 8 cm from the pylorus, and that the part of the body of the catheter arranged above the inflated balloon is wedged against the wall of the lesser curvature of the stomach,   iv. on one hand, the catheter is used to guide the surgeon for resection of a part of the stomach by determining the position of the start of the line for resection and closure (stapling-suture) in the area of the pyloric antrum and, on other hand, is used to define the closure resection line, giving him anatomical reference points and a support for his instruments during these closure resection steps,   v. calibrating the gastric sleeve and the pyloric antrum to be preserved,   vi. injecting and then withdrawing coloured liquid in the patient's stomach, after closure, to verify hermeticity of the closure line,   vii. and optionally introducing means for visualization (light source) into the stomach.