METHOD OF SUTURING OF DUODENAL STUMP

I.I. TARANOV, V.A. BONDARENKO, V.A. PETRENKO,

A.A. KOLESNICHENKO, M.A. MAMEDOV

Rostov State Medical University, Rostov-on-Don, RUSSIA

Introduction: As is known, the number of emergency operations for such life-threatening complications of peptic ulcer as bleeding and ulcer perforation has increased in 1.5-2.0 times recently. At the same time in patients during operation of gastrectomy are revealed rough scarry - inflammatory changes in gastroduodenal area, generating technical difficulties for a closure of duodenal stump, especially in patients with ulcers penetrating in pancreatic head or liver gate.

Materials and methods: We have developed a new method (patent of RF № 2308238) of suturing of duodenal stump in these cases. It consists in the following. The anterior wall of duodenum is intersected in transverse direction to 2.0-2.5 cm above the lower edge of an ulcer. Then the upper and the lower wall of duodenum are intersected towards the center of ulcerative defect. The resulting lumen of duodenal stump is sutured by separate seams between its anterior and posterior walls. Ligatures are tied after applying all the seams. This results in approximation of anterior and posterior walls of duodenal stump with simultaneous output of an ulcer beyond the lumen of duodenum. In the next stage the first row of seams of a stump and ulcerative defect are covered with the entire thickness of the round ligament of liver. For this, the entire thickness of the round ligament of liver in the projection of the formed duodenal stump is underrun from right to left in the transverse direction, capturing its tissues into a suture in a volume of 2.0-2.5 cm in a diameter. Then with the same needle the capsule of pancreas is underrun above the upper pole of ulcerative defect and anterior wall of a stump is underrun serous-muscularly. Stepping 2.5-3.0 cm below the first ligature identically impose a second ligature through the entire thickness of the round ligament of liver with the capture into a suture of a capsule of pancreas below the lower pole of ulcerative defect and underruning serous-muscularly the anterior wall of the stump. Assistant with swabs brings the round ligament of liver closer to the stump and the surgeon ties starting with the first and then the second ligature. In cases of large-sized ulcerative defects are imposed additional sutures in the intervals between these ligatures.

Results: The closure of duodenal stump by this method was carried out in 19 patients. Failure of stumps sutures or other complications were not observed

Conclusions: Thus, in stomach resections on ulcers penetrating into pancreatic head or liver gate it is possible to suture duodenal stump with the use of entire thickness of the round ligament of liver.

ENDOSCOPIC PROGRAMMED HEMOSTASIS: FUNDAMENTAL FEATURES OF PERFORMANCE IN ULCERATIVE GASTRO-DUODENAL BLEEDINGS IN PATIENTS WITH A HIGH OPERATIONAL AND ANESTHETIC RISK.

L.Y. TIMEN

City Clinical Hospital № 20 Moscow, RUSSIA

The treatment of ulcerative gastroduodenal bleedings (UGDB), despite the wide range of modern treatment methods, including endoscopic hemostasis (EH), does not bring satisfaction to a clinician due to frequent recurrences of bleeding (RB) and postoperative mortality of 82-94% in patients with high operational and aesthetical risk (HOAR). Unsuccessful results of EH, in our opinion, were caused by the fact that the used methods have provided only a contact exposure to the source of bleeding and did not include the prophylaxis of RB.

Materials and methods: Was completed the research program aimed to the development of a fundamentally new method of EH in UGDB in patients with HOAR based on the principles of its correspondence to pathogenesis of severe blood loss and hemorrhagic shock (SBL and HS) and pathophysiological features of the course of peptic ulcer. In the study of pathomorphology of SBL and HS in the sectional material of 38 patients died of UFDB, it was found that the death of patients was caused by profound disturbances of homeostasis and energy depletion. Significant violations of a local metabolic status during experimental ulcer formation were noted in the description of metabolic processes by indicating the end products of metabolism of purine metabolites in gastric mucosa by means of "liquid chromatography". At the same time was determined the usefulness of local metabolic correction (MC) for SBL and HS with the usage of sources of energy supply (5% solution of glucose), antioxidants-reparants (5% solution of ascorbic acid) and respiratory chromogens (1 % solution of methylene blue). These substances were the ingredients of the developed method of endoscopic programmed hemostasis (EPH) for persons with HOAR. The performance of EPH simultaneously solves a triple challenge: emergency hemostasis, preventive metabolic homeostasis and local treatment of peptic ulcer.

The results of EPH: RB with 22.2% mortality rate occurred in 5.5% of patients with SBL and HS. In the absence of EH lethal outcomes after emergency interventions and conservative treatment were 47.4% and 30.2%.

Conclusion: The results of clinical testing of the method of EPH indicate the appropriateness of conducting of MC for prevention of RB in patients with UGDB and HOAR.

FACTORS AFFECTING THE SUCCSESS OF ENDOSCOPIC BOUGIA DILATATION OF RADIATION INDUCED ESOPHAGEAL STRICTURE

Y. TUNA*, E. KOÇAK**, D. DINÇER*, S. KÖKLÜ**

*Akdeniz University Medical School of Medicine, Antalya;

** Ankara Education and Research Hospital, Ankara, TURKEY

Aim and Background: The purpose of this retrospective study was to assess clinical outcomes of endoscopic bougie dilation of esophageal strictures after radiation therapy for head and neck cancer, and to assess the risk factors which affect the treatment success.

Material and Methods: 31 patients with esophageal stricture due to radiation therapy were treated with endoscopic bougie dilation. The following parameters were evaluated; age, gender, primary site of the tumour, initial treatment of the tumour, prescribed dose of radiation, the time to onset of esophageal stricture after RT, grade of esophageal stricture according to clinical and endoscopic findings, number of dilatations, recurrence of esophageal stricture, and the result of the therapy.

Results: The average follow-up was 26 months with a range of 1 to 84 months. Successful endoscopic bougie dilation was achieved in 26 of 31 patients. The median time to onset of esophageal stricture after RT was significantly shorter in patients who did not respond to endoscopic bougie dilation.

Conclusion: Endoscopic bougie dilation is a safe and effective procedure for the management of radiation induced esophageal stricture. Time to onset of esophageal stricture is the most important factor for the treatment success. In addition, the total prescribed dosage of radiation has minimal effect on the result of endoscopic bougie dilation.

Date: 2014-12-28; view: 1002