RESULTS OF THE IMPROVED METHOD OF FORMATION OF GASTROTRANSPLANT IN SUBTOTAL ESOPHAGEAL EXTIRPATION

Z.M. NIZAMKHOJAYEV, R.E. LIGAY

Republican Specialized Centre of Surgery named after acad. V. Vakhidov, Tashkent,

UZBEKISTAN

Purpose: To develop an improved method of formation of transplant from the stomach after extirpation of the esophagus.

Material and methods: 106 subtotal extirpations of the esophagus for various esophageal diseases: cancer in 83 patients, esophageal achalasia of the 4^th stage in 15, post-burn cicatricial strictures in 5 and stenosing reflux esophagitis in 3 patients were performed from 1997 to 2011 at the Department of esophageal and gastric surgery. All patients operation was single-staged with the formation of extracavital esophago-gastric anastomosis in the neck. In the department there was developed and introduced into clinical practice an original method of forming of a transplant from the greater gastric curvature for which there was obtained a patent for the invention No 03872 (“Method of forming gastrotransplant in esophagoplasty”), which was used in these 106 patients.

Results and discussion: The use of greater curvature of the stomach as a transplant is more preferable as compared to small and large intestine. The main requirements to gastrotransplant are: sufficient length of gastric tube and good blood supply, which allows to form the esophago-gastric anastomosis in neck.

The essence of the proposed method of transplant formation consist in the maintenance of two feeding vessels: the right gastroepiploic artery and right gastric artery to improve blood supply. Antral portion of the stomach serving as a reservoir, which provides a portion and rhythmic type of evacuation is maintained. The proposed method is performed as follows: mobilization of the stomach along both curvatures with the maintenance of the right gastric feeding and right gastroepiploic arteries, the stomach is dissected from the lesser curvature at a distance of 7 cm from the pylorus, with preservation of the anatomical integrity of the antral part. Gastrotransplant in the form of isoperistaltic tube of the greater curvature with the use of precision technology for the closure of small curvature, that is separate device suturing of muco-submucosal layer and manual nodal peritonizing sutures on sero-muscular layer of the stomach, due to which it becomes possible to lengthen the transplant by 7-10 cm, as no deformation takes place. The maintained antrum provides not only the reservoir function, but also provides a portion-rhythmic type of evacuaton from the transplant, which is confirmed by X-ray and radioisotope examinations. In all cases the formed transplant was of sufficient length for the creation of an esophageal anastomosis on the neck. The analysis of the nature of direct post-operative complications showed that end necrosis of a transplant occurred only in 1 case, which constituted 0.9%, with no fatal outcomes and repeated surgical intervention. Esophagogastroanastomotic insufficiency occurred in 9 (8.4%) patients. Fatal outcome occurred in 8 patients, that is. 7.5% of patients.

Conclusions: The proposed method of forming an isoperistaltic tube from greater curvature of a stomach with preservation of the antral and the right gastric artery makes it possible to create a transplant of a necessary length, with an adequate blood supply and preserved reservoir and evacuation function of the gastric transplant.

ENDOSCOPIC AND MORPHOLOGICAL FEATURES OF THE UPPER GASTROINTESTINAL TRACT PATHOLOGY IN ADOLESCENTS OF SAKHA REPUBLIC (YAKUTIA)

M.V. PAK, N.V. SAVVINA, S.N. LEHANOVA

YRH №1, Yakutsk, RUSSIA

The purpose of the study. Identify the endoscopic and morphological changes in the gastric mucosa in the HP-associated gastritis in adolescents living in the Republic of Sakha (Yakutia).
Material and methods. Endoscopic and histologically studied 188 biopsies of the stomach antrum in children aged 10 to 17 years with the clinical picture of dyspepsia, including 69 girls and 119 boys. In the structure studied, indigenous children -131, non-indigenous - 75.

Results. Adolescents 10-17 years dominate simple forms gastroduodenitis. The frequency of HP infection in the general structure of the surveyed adolescents aged 10-17 years was 58,5% (p = 0,01). Chronic gastritis in children 10-14 years are associated with the second and third degrees of HP infection, and adolescents 15-17 years with first degree of infection and their lack of HP.

Conclusion. In the adult population of Yakutia HP infection occurs mainly in childhood and increases with age, since early childhood - a critical period for HP infection. Chronic infection caused by Helicobacter pylori, in leads to Multifocal or diffuse atrophic gastritis and metaplasion of the gastric epithelium.

SELECTION OF TREATMENT STRATEGY FOR PILORODUODENAL ULCERS, ASSESSMENT OF THE ROLE OF HELICOBACTER PYLORI IN THE PREDICTION OF RECCURENCES AND COMPLICATIONS

E.A.RUSTAMOV

Scientific Center of Surgery after named akad. M,A,Topchubashev, Baku, AZERBAIJAN

Dependence of the Helicobacter pylori (HP) contamination in patients with piloroduodenal ulcers on the clonical course of the disease and form of complications, age, sex of the patients, duration of the disease, localization of the ulcer, anastomo-morfologic features of ulcer substrate, type of the conducted treatment (antihelicobacter and surgical), post operative recurrent ulcers was studied. Diagnosis of HP was carried out by the method of histologic examination. Examination was carried out on 538 patients with piloroduodenal ulcers. 76(14,1%) of the examined patients had uncomplicated ulcer, 60 (11,1%) frequently recurring ulcer, in 46 (8,5%) long-term non-scarring ulcer. Moreover, 51 (9,5%)patients had bleedings, 60 (11,1%) patients had piloroduodenal stenosis, 30 (5,6%) patients penetrations. At the same time, 52 (9,7%) patients were after the suturing of perforated ulcer, 51 (9,5) patients after SPV, 56 (10,4%) patients after fgastric resection. 38 conventionally practically healthy persons were included into the control group. Subject to the features of clinical course of ulcer diseases and form of complications comparative analysis of Hp contamination showed that there is a significant difference between Hp-poaitive and Hp-negative groups – in patients with such complications as frequently recurring ulcer (13,1±1,6%, 2,1±1,5% respectively), bleeding (11,0±1,5%, 2,1±1,5% respectively) and stenosis (respectively 14,0±1,6%, 2,1±1,5%). However, there was not determined significant difference between complications (bleeding, stenosis, penetrations) according to the frequency pf Hp contaminations. There was confirmed that it is more characteristic for such complications as bleeding and stenosis (p<0,001). Hp contamination was observed in 75% of piloric localization, 83,9% of duodenal localization, 100% of joint localization. Hyperemia and swelling of the mucous coat of stomach, hyperacid conditions, sizes of the ulcer up to 1.0 cm, was statistically characteristic for Hp-positive condition.

Thus, such complications as recurrent form of ulcer disease, bleeding, stenosis, post SPV recurrent ulcer, piloroduodenal and joint localization of ulcer substrate, mucous hyperemia and swelling, hysperacid conditions, sizes of the ulcer up to 1.0 cm, may be considered prognostic risk factors of Hp contamination and complications of the diseases. Prepared prognostic criteria, preventive operations before complications (SPV) , elimination of Hp before and after operation, realizes improvement of the result of treamtment and life standards of patients.

PROPHYLACTIC METHOD OF THE HEALING PROCESS AT THE UPPER SEGMENT OF THE ABDOMINAL CAVITY AFTER SELECTIVE PROXIMAL VAGOTOMY

E.A.RUSTAMOV

Scientific Center of Surgery named after acad. M.A. Topchubashov, Baku,AZERBAIJAN

Healing process at the upper segment of the abdominal cavity after selective proximal vagotomy (SPV) realizes motor and evacuation disorders of stomach, constituting one of the reasons of recurrent ulcers. Prophylactics of the healing process indirectly leads to the prophylactics of recurrent ulcers. We have developed the following method for the prophylactics of the healing process at the upper segment of the abdominal cavity after SPV (Patent for invention No. 010928 Eurasian patent organization, 2008).

The aim of the prophylactic method: To prevent recurrence of ulcers by the prophylactics of the healing process at the upper segment of the abdominal cavity after SPV. Technical solution of the offered prophylactic method: SPV is performed by the isolated (without drainage operation of stomach) or jointly with drainage operation. A slice on wide pedicle of respective size is prepared for the part from greater omentum to smaller curvature of the stomach rehabilitated according to SPV. The prepared slice is spread on the anterior wall of the stomach above the suture line in accordance with peritonization particular to SPV in the small curvature by passing from the posterior part of stomach through the window (from mobilization part of the greater curvature in accordance with large SPV) formed due to cutting of right and left stomach-omentum vessels jointly with parasympathetic nerve fibers accompanying then on the greater curvature of stomach, and fixed to the wall of stomach on three spots. In the variant without large SPV, the slice made of small omentum is in mobile manner fixed to the posterior wall on three spots by passing from the anterior wall of the stomach through the part of the small curvature mobilized in accordance with SPV. When SPV is carried out by means of drainage operation, on the suture line of the drainage operation and slice of respective size is made of omentum, spread and fixed on one or two spots. In the fixed variants of greater omentum the operation for the extension and freeing of the slice due to its mobilization. Thus, the part of the stomach exposed to SPV ++ drainage operation is placed between biologic, elastic mobile pad made of omentum. The pad functions as a biologic barrier between the stomach and neighboring organs, prevents the process of healing, and provide normal activity of the stomach. Difference of the offered method from existing methods: 1) the method is simple, and can be easily applied; 2) it is not strange for the organism because of the use of automaterials, it does not create problems; 3) economically beneficial as compared to offered methods for the prevention the healing process by means of medicinal; 4) because of more reliable prevention of the healing process, it does not disturb the postoperative motor and evacuation function of stomach, prevents formation of recurrent ulcers.

The method was applied in 25 patients during the surgical treatment of piloroduodenal ulcers by means of SPV at the surgical gastroenterology department of SSC named after M.A.Topchubashov. No evacuation disorders and recurrent ulcers were observed in postoperative period.

Date: 2014-12-28; view: 970