THE PLACE OF ROUX RECONSTRUCTION IN THE CORRECTION OF POSTGASTRORESECTIONAL SYNDROMES

N.V. GIBADULIN, I.O. GIBADULINA

Central Research Institute of Gastroenterology, Moscow, RUSSIA

Introduction: A large number of methods of surgical correction of postgastroresectional syndromes suggest, first of all, a dissatisfaction of surgeons with the outcomes of reconstruction, and hence the question of choosing the method of surgical treatment of the most spread forms of diseases of operated stomach remains important.

Material and methods: The present study included 14 patients with the disease of operated stomach (13 males and 1 female). The average age was 54,7 ± 2,4 years. All patients had previously undergone the distal stomach resection by Billroth-II in the modification of Hofmeister-Finsterer for complicated gastroduodenal ulcers. Deadline of reconstructive interventions with respect to the primary operation ranged from 10 months to 3.5 years (1,2 ± 0,4 years). Indications for reconstructive interventions in the vast majority were peptic ulcers of gastroenteroanasthomosis, usually combined with a pronounced enterogastroesophageal reflux, dumping syndrome and / or afferent loop syndrome.

Results and discussion The bases for the selection of the method of reconstruction were the works of prof. G.K.Zjerlov on the formation of functionally active sphincteral-valval anastomoses. All patients passed a re-resection of a gastric stump by Roux with correction of esophagocardial transition and the creation of a deterrent mechanism in the efferent loop of small intestine through the formation of invaginated valve. Lethal outcomes and specific postoperative complications were not observed. Early complications of a general surgical nature aroused in one patient (7.1%) and were associated with the development of acute pancreatitis, arrested by a conservative treatment. The postoperative hospital stay averaged in 11,7 ± 2,12 days. In the immediate postoperative period 13 (92.9%) patients evaluated the treatment outcomes as good or excellent. A recurrence of a peptic ulcer in the efferent intestine in the presence of a normal concentration of gastrin in serum was diagnosed in one patient. It was regarded as an unsatisfactory result of re-resection of stomach, requiring further antiulcer therapy. In our view, the restoration of motor-evacuation function of upper gastrointestinal tract after gastric re-resection is provided by the formation of a tubular gastric stump which significantly delays its evacuation and by implementation of bilateral symmetrical esophagofundorafia of Toupet type and the creation of invaginated valve in the efferent loop of small intestine. Formation of the latter allows refusing from a resection of the previously formed interintestinal anasthomosis with saving of a significant portion of jejunum for digestion. Prevention of a relapse of peptic ulcer consists in performing of a selective vagotomy by the way of parietal denervation of small curvature of a gastric stump and abdominal part of esophagus. Thus, Roux-reconstruction allowed delivering the vast majority of patients from clinical symptoms of postgastroresectional syndromes, and, as a consequence, significantly reducing the percentage of inflammatory changes of mucous membrane of esophagus and gastric stump.

Conclusion: Technically simple Roux-reconstruction, complemented by the formation of functionally active sphincteral-valval anastomoses, can serve as an alternative secondary jejunogastroplasty, especially in patients with "difficult" duodenal stump. The use of methods of functional surgery in the performance of reconstructive operations in most cases can safely arrest the main manifestations of diseases of operated stomach and, ultimately, improve the quality of life of this category of patients.

IMPROVED METHODS OF PREVENTION OF

Date: 2014-12-28; view: 796