RU2523657C1 - Method for formation of mechanical oesophagoenteroanastomosis with duodenal passage recovery in gastrectomy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: gastrectomy and lower thoracic esophagectomy are performed from a supramedian laparotomic approach. A Roux-opened defunctioned small intestinal loop is formed. A mechanical end-to-side oesophagojejunoanastomosis with a 'free' end of the abducent jejunum is formed. An end-to-end jejunoduodenoanastomosis is formed between a duodenal stump and a 'free' end of the jejunum.

EFFECT: forming the oesophagoenteroanastomosis with the duodenal passage recovery.

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Description

The invention relates to medicine, namely to surgery.

Currently, the development of surgical technique, anesthesiology, and resuscitation has improved the immediate and long-term results of surgical treatment of gastric cancer. Including gastrectomy for cancer of the proximal stomach, they are widely performed. Due to more aggressive surgery for gastric cancer in all stages, the 5-year survival rates improved, which increased the surgeons' interest in finding and developing various types of reconstruction after gastrectomy, in terms of their physiology and quality of life for patients [1, 2]. Various methods of anastomosing the esophagus and small intestine are known and widely used for gastrectomy for gastric cancer [3]. There are various approaches to anastomosing these sections of the digestive tract:

invagination, immersion anastomoses, anastomoses, providing for enveloping the line of the esophageal-intestinal suture of the adducting, abducting, or both loops of the small intestine.

However, the proposed methods are technically complex, and surgery takes considerable time. The need to form an anastomosis with the lower thoracic esophagus leads to a high invasiveness of surgical access (simultaneous laparo - and thoracotomy), and the results are not always satisfactory. Thus, the search continues for a technique that will reduce the time of surgery (by simplifying the technique of surgery) and surgical trauma, reduce the number of postoperative complications and improve treatment outcomes in this group of patients [4].

The problem solved by the present invention is the development of methods for the formation of esophagoenteroanastomosis with subsequent restoration of the passage through the duodenum 12 when performing gastrectomy.

Achievable technical result is: providing a satisfactory result of surgical treatment of gastric cancer by using the proposed methodology for the formation of hardware esophagoenteroanastomosis with subsequent restoration of the passage through the duodenum.

Thanks to the proposed technical features, surgical intervention is technically simple (considering the use of a stapler), performed in compliance with the principles of oncoradicalism and performed from laparotomic access, even if the lower thoracic esophagus is resected, thereby reducing surgical trauma and reducing the time of surgical intervention and anesthetic management, which leads to a favorable course of the postoperative period, a low number of postoperative nnyh complications and reduce the duration of treatment in this group of patients, as well as to a reduction in terms of their social and occupational rehabilitation.

The restoration of the passage through the duodenum after the formation of esophagoenteroanastomosis allows improving the quality of life of patients after surgery by maintaining the physiological passage of food through the gastrointestinal tract.

The method is as follows.

An analogue of this technique is the method of forming the esophageal-enteric anastomosis in the surgical treatment of cardioesophageal cancer (patent No. 2391055 C2, Baryshev A.G., Kryzhanovsky A.A., Mednikova N.V.).

The proposed technique is performed in patients who have established indications for gastrectomy and resection of the lower thoracic esophagus.

An upper-midline laparotomy is performed. Next, a gastrectomy, resection of the lower thoracic esophagus with lymphadenectomy D2-D3 is performed according to the generally accepted method. After this, a loop of the small intestine disconnected along Ru is formed. A circular stapler, for example, EEA DST 25, is inserted into the “free” end of the intestine. The “cap” of the apparatus is fixed in the distal end of the esophagus with a purse string suture. Then the hardware esophageoyunoanastomosis "end to side" is formed. After this, the cross-linking circular apparatus is removed from the “free” end of the loop of the small intestine and a single-row end-to-end single-duodenoanastomosis is formed (in order to restore the passage through the duodenum). Next, sanitation, drainage and suturing of the abdominal cavity are performed according to the generally accepted technique.

Thus, the main stages of the operation are as follows.

1. Gastrectomy, resection of the lower thoracic esophagus with lymphadenectomy.

2. Formation of a loop of the small intestine disconnected by Ru.

3. The formation of hardware esophageoejunoanastomosis "end to side" between the distal section of the esophagus and the discharge section of the jejunum.

4. Restore the passage through the duodenum 12 by forming end-to-end jeunoduodenoanastomosis between the duodenal stump 12 and the discharge site of the jejunum.

Clinical example: Patient B., 36 years old, was admitted to the SRI SR with a diagnosis of gastrointestinal bleeding. During the examination: according to endoscopy, there is a tumor in the upper third of the stomach with a transition to the cardial part of the esophagus, signs of gastrointestinal bleeding. After additional examination and preoperative preparation under general anesthesia, the patient underwent upper-midline laparotomy. No metastases and enlarged regional lymph nodes were found in the abdominal cavity. Given the presence of a tumor in the upper third of the stomach with a partial lesion of the lower thoracic esophagus, it was decided to perform a gastrectomy with lymphadenectomy D3 according to the proposed method. After gastrectomy and resection of the lower thoracic esophagus, a loop of the small intestine is disconnected along Ru. A circular stapler EEA DST 25 is inserted into the outlet end of the intestine, the “cap” of which is previously fixed in the distal end of the esophagus with a purse string suture. Next, a hardware end-to-side esophagoejunoanastomosis was formed. After this, the cross-linking circular apparatus is removed from the "free" end of the loop of the small intestine and a single-row end-to-end single-duodenoanastomosis is formed. Next, rehabilitation and drainage of the abdominal cavity, suturing of the anterior abdominal wall were performed.

Literature

1. Chissov V.I. Malignant neoplasms in the Russian Federation in 1993 // Collection of statistical materials. - M., 1995.

2. Chernousov AF, Polikarpov SA. Extended lymphadenectomy in surgery for gastric cancer. Moscow. EDIT. 2000.

3. Shalimov A.A., Saenko V.F. Digestive tract surgery. - Kiev: Health, 1987. - 586 p.

4. Smirnov A.I. Clinical endoscopic and morphological criteria for evaluating the esophageal anastomoses after primary and reconstructive operations: Dis. Cand. honey. sciences. Tomsk 2003; 176.

Claims (1)

A method of forming a hardware esophagoenteroanastomosis with restoration of the passage along the duodenum during gastrectomy, including performing upper-mid-median laparotomy, resection of the lower thoracic esophagus, gastrectomy with lymphadenectomy, forming a loop of the jejunum disconnected along the Rope, introducing the circular end into the apparatus with the free end , The “hat” of which is preliminarily fixed in the distal end of the esophagus with a purse string suture, then the end-to-side hardware esophageojejunoanastomosis is formed, stitching The first circular apparatus is removed from the “free” part of the jejunum and a single-row end-to-end single-duodenoanastomosis is formed.