RU2184494C2 - Method for making stomach resection in experiment - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves stitching separate corrugating sutures all over the stomach circumference through the whole wall thickness in a way that stomach stump diameter would coincide with duodenum diameter. Serous, muscular and submucous layer is notched more proximal with respect to the corrugating suture line. Pyloroanthral portion of the stomach is removed somewhere distal with respect to the corrugating suture line. Gastroduodenal end-to-end anastomosis is created with the first row of sutures. Then, the first row of anastomosis sutures is covered with seromuscular stomach envelope prepared in advance. EFFECT: avoided gastroduodenal reflux complication. 8 dwg

Description

 The invention relates to medicine, namely to surgical treatment of gastric ulcer.

 From practical medicine, methods for resection of the stomach are known, consisting in resection of the pyloric antrum with the formation of lesser curvature and the application of anastomosis of the stomach with the duodenum (A. G. Zemlyanoy. Resection of the stomach. - L .: 1975).

 There is also known a method of resection of the antrum with the preservation of the pylorus and the application of an anastomosis with the proximal part of the stomach (G.L. Alexandrovich. Resection of the stomach with preservation of the pylorus in peptic ulcer. - Khabarovsk, 1978. - 128 S.).

A disadvantage of the known methods is:
- the formation of small curvature lengthens the operation time;
- the presence of a weak spot at the point of intersection of the seam line of small curvature with the seam line of the anastomosis;
- the possibility of bleeding from the mucous or submucosal layers;
- uncontrolled passage of gastric contents.

 The closest way to the proposed one is the method of gastrectomy with the creation of pulp in the area of the anastomosis of the stomach and duodenum (G.K. Zherlov, G.Ts. Dambaev, N.I. Bogomolov. Resection of the stomach with the creation of pulp in the anastomosis in case of peptic ulcer. // Clinical chir. - 1983. - 8 - p. 33-36).

However, the known method has the following disadvantages:
- the formation of small curvature and the imposition of reinforcing seams lengthen the operation time;
- the presence of a weak spot at the point of intersection of the seam lines of small curvature with the seam line of the anastomosis;
- the cut muscle pulp is subsequently sclerosed, which can lead to the development of stenosis of the gastrointestinal anastomosis;
- the possibility of bleeding from the mucous or submucosal layers.

 The aim of the invention is to improve the results of surgical treatment of gastric ulcer.

 The goal of the invention is achieved by the fact that corrugate all layers of the wall of the stomach with separate interrupted sutures, followed by circular dissection of the serous-submucous layers for subsequent covering of the anastomosis line with the serous-submucous case.

The use of corrugating nodal joints across the entire wall of the stomach allows you to:
- prevent bleeding from the area of the anastomosis;
- narrow the lumen of the stomach to the appropriate diameter of the duodenum;
- reduce the operation time by 1 hour compared with known methods, reduce the invasiveness of the operation.

 The cut serous-submucous case is not sclerosed, it allows to increase reliability and create favorable conditions for the healing of this anastomosis.

 Serous-submucous case promotes portioned evacuation of gastric contents, which prevents duodeno-gastric reflux.

The proposed invention is illustrated by figures where:
figure 1 - mobilization of the pyloric antrum;
figure 2 - corrugation with interrupted sutures of the anterior wall of the stomach;
figure 3 - corrugation of the posterior wall of the stomach with interrupted sutures;
figure 4 is a circular incision of serous-submucosal layers of the stomach;
FIG. 5 - application of the end-to-end anastomosis of the stomach with the duodenum;
6 is a shelter line seams serous-submucosal case.

 Our proposed method was tested on 7 dogs in experimental surgery of the Central Scientific Research Laboratory of the Astrakhan State Medical Academy during 1997-1998.

 Below are the results of testing.

 Example 1. A dog named B., gender - female, weight - 10 kg., Operation 12/15/97.

 Under general anesthesia, a median laparotomy was performed. Portions mobilized large curvature, small curvature, the initial part of the duodenum. Separate corrugating sutures are placed along the entire circumference of the stomach, along the entire circumference of the stomach, through the entire wall thickness, so that the diameter of the stomach stump coincides with the diameter of the duodenum. Proximal to the line of the corrugating joints, the serous-muscular-submucosal layers were cut. Distal to the line of the corrugating joints, the remaining part of the stomach was cut off. The first row of sutures is laid end to end with the duodenum. Then, the first row of sutures of the anastomosis is covered with previously prepared serous-muscular-submucous case of the stomach. Control of hemostasis. Layered seams on the wound. The postoperative period was uneventful. Complications in the early and late postoperative period were not observed. 1 month after the operation, fibrogastroduodenoscopy was performed: we pass the esophagus. Cardiac pulp closes completely. In the lumen of the stump of the stomach, a moderate amount of light mucus. The mucous is pink, the folds are thickened, swollen. Peristalsis of medium depth. The pulp of gastroenteroanastomosis is rounded, closes completely. On the back wall of the gastroenteroanastomosis, a single catgut ligature, which is in the stage of rejection, is visible. There is no pathology in the duodenum.

 Conclusion: a single ligature of gastroenteroanastomosis. Superficial gastritis of a stomach stump.

The essence of this survey is illustrated by photographs, where:
Photo 1: a relaxed state of pulp;
Photo 2: closed pulp state.

 Example 2. A dog named O., gender - female, weight - 12 kg., Operation 01/28/98.

 According to our technique, a resection of the stomach was performed. The postoperative period was uneventful. Complications in the early and late postoperative period were not observed. 1 month after the operation, a contrast fluoroscopy was performed: the stomach was not stretched, the wrinkles were wrinkled, barium suspension was determined from the stomach to the duodenum in portions. Batch evacuation begins after 6 minutes and lasts for two hours.

The proposed method has advantages compared with the known method:
- when using the claimed method in comparison with the known method, the elimination of postoperative complications was achieved;
- when using the inventive method, the operation time is reduced by 1 hour;
- when using the claimed method, a partial outflow of gastric contents was achieved;
- serous-muscular-submucosal case has revascularizing properties;
- wrapping the anastomosis with a serous-muscular-submucous case from the proximal part of the stomach reduces the risk of failure of sutures and peritonitis;
- favorable conditions are created for the healing of the anastomosis;
- the serous-muscular-submucous case is not sclerosed.

 The proposed method was recommended in wide clinical practice.

Claims (1)

 The method of gastric resection in the experiment, including the removal of the pyloric antrum, characterized in that, along the entire circumference of the stomach, separate corrugating sutures are applied across the entire wall thickness so that the diameter of the stomach stump coincides with the diameter of the duodenum, serous, muscular and submucosal layers, after which the pyloric antrum is removed distally to the line of the corrugating sutures, the first row of sutures form the anastomosis of the stomach end to end with twelve intestine, then the first row of sutures of the anastomosis is covered with a pre-prepared serous-muscular-submucous case of the stomach.

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