RU2211670C1 - Method for carrying out proximal stomach resection in experiment - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves removing cardiac portion of the stomach, fundus and some parts of stomach body. Serosubmucous layer on the anterior and posterior stomach walls are circularly dissected. Mucous membrane is separated over 1 cm of the remaining stomach part. Mucous membrane is narrowed with interrupted surgical sutures to match esophagus diameter. The first suture row is applied between gastric mucous membrane and esophageal one. The anastomosis line is covered with circularly dissected serosubmucous envelope. EFFECT: reduced risk of anastomosis suture inconsistency. 4 dwg

Description

 The invention relates to medicine, namely to surgical treatment of gastric ulcer, tumors of the stomach and abdominal esophagus, stenosis of the cardiac section of the stomach.

 From practical medicine, methods of proximal resection of the stomach are known, consisting in resection of the abdominal esophagus, cardiac section and fundus of the stomach with the application of an invagination anastomosis of the esophagus with the stomach (Peterson B.E. Anastomoses during gastrectomy and resection of the esophagus. - M., 1962, 83 from.).

 There is also known a method of proximal resection of the stomach with the application of an anastomosis between the esophagus and the stomach with plastic cover by biological tissues (Shalimov A.A., Saenko V.F., Shalimov S.A.Surgery of the esophagus. - M., 1975, 67 S. )

The disadvantages of the known methods are:
- bleeding from the anastomosis zone,
- the presence of a weak spot at the point of intersection of the seam line of small curvature with the line of the anastomosis,
- the possibility of bleeding from the mucous and submucosal layers,
- uncontrolled passage of contents from the esophagus to the stomach,
- scarring of the esophago-gastric anastomosis,
- throwing the contents of the stomach into the esophagus with the development of reflux esophagitis,
- failure of anastomotic sutures.

 The closest way to the proposed one is the method of proximal resection of the stomach with anastomosis line cover by the anterior wall of the stomach according to Kirchner (Shalimov A.A., Saenko V.F., Shalimov S.A. Esophagus surgery. - M., 1975, 67 p. .).

However, the known method has the following disadvantages:
- the possibility of bleeding from the mucous and submucosal layers,
- uncontrolled passage of contents from the esophagus to the stomach,
- the possibility of developing stenosis of the esophageal-gastric anastomosis,
- throwing the contents of the stomach into the esophagus with the development of reflux esophagitis,
- failure of the joints of the anastomosis,
- the formation of small curvature and the imposition of reinforcing seams lengthens the operation time.

 The aim of the invention is to improve the results of surgical treatment of gastric ulcer, tumors of the stomach and abdominal esophagus, stenosis of the cardiac section of the stomach.

 The goal of the invention is achieved by the fact that they produce a circular dissection of the serous-submucosal layers on both the anterior and posterior walls of the stomach, followed by demucosis for 1 cm of the remaining part of the stomach, with narrowing of the mucous membrane with interrupted sutures to the corresponding diameter of the esophagus, with application the first row between the narrowed gastric mucosa and the esophagus, followed by covering the anastomosis line with a circularly dissected serous-submucous case.

Using the proposed method allows you to:
- prevent bleeding from the area of the anastomosis,
- narrow the lumen of the stomach to the appropriate diameter of the esophagus,
to reduce the operation time by 1 hour compared with known methods and reduce the invasiveness of the operation,
- reduce the risk of failure of the joints of the anastomosis,
- exclude the possibility of developing reflux esophagitis.

 The cut serous-submucous layer is not sclerosed, it allows to increase reliability and create favorable conditions for the healing of this anastomosis. Serous submucosal layer prevents the development of reflux esophagitis.

The proposed essence of the invention is illustrated by drawings, where:
FIG. 1 - mobilization of the proximal stomach and circular dissection in the oblique direction of the stomach to the mucous membrane;
figure 2 - demucosis of the remaining part of the stomach for 1 cm;
figure 3 - the imposition of nodal catgut sutures on the mucous membrane of the anterior and posterior walls of the stomach;
FIG. 4 - application of the end-to-end anastomosis between the esophagus and stomach and the covering of the suture line of the anastomosis of the serous-submucosal layers.

 The method proposed by the authors was tested on 6 outbred dogs in an experiment during 2000-2001 at the department of hospital surgery.

 Below are the results of testing.

Example 1
A dog named M., gender - female, weight - 10 kg, operation 15.09.2000.

 Under endotracheal anesthesia, a median laparotomy was performed. The stomach is withdrawn into the wound. The mobilization of the proximal stomach and abdominal esophagus was performed. A circular incision in the oblique direction cuts the stomach to the mucosa. The serous-submucosal layer was separated by 1 cm below the initial incision. Nodal catgut sutures were applied to the mucous membrane on both the anterior and posterior walls. Thus, the opening of the stump of the stomach is narrowed to the diameter of the esophagus. After cutting off the proximal part of the stomach from the esophagus, the first row of nodal sutures was placed between the mucosa of the esophagus and the stomach. The first row of seams is additionally covered by the resulting serous-submucous case. Control of hemostasis. Antibiotics are introduced into the abdominal cavity. Sutures were laid on the wound in layers. The postoperative period was uneventful. Complications in the early and late postoperative period were not observed.

Example 2
A dog named O., gender - female, weight - 12 kg, operation 03.25.2001.

 According to the technique developed by the authors, proximal gastrectomy was performed. The postoperative period was uneventful. No complications were observed. 1 month after the operation, a contrast fluoroscopy was performed.

 A barium suspension was given through a probe into the esophagus. After filling the esophagus with barium, after 1 min a portioned intake of suspension into the stomach was noted. The esophagus is not stretched, longitudinal folds. After 7 minutes, a portioned evacuation of barium suspension from the stomach to the duodenum begins. Barium is not thrown into the esophagus.

The proposed method has advantages compared to the known method:
- when using the claimed method, the elimination of postoperative complications was achieved,
- when using the claimed method, a partial outflow from the esophagus to the stomach is achieved,
- serous-submucosal layer has revascularizing properties,
- wrapping the anastomosis line with a serous-submucosal layer reduces the risk of failure of the joints,
- favorable conditions are created for the healing of the anastomosis,
- serous-submucous case is not sclerosed,
- bleeding from the anastomosis zone is completely prevented.

 The proposed method can be recommended in wide clinical practice.

Claims (1)

 The method of proximal resection of the stomach in the experiment, consisting in the removal of the cardiac section, the bottom of the stomach and part of the body of the stomach, characterized in that they make a circular dissection of the serous-submucosal layers on both the front and rear walls of the stomach, followed by demucosis for 1 cm remaining parts of the stomach, with a narrowing of the mucous membrane by interrupted sutures to the corresponding diameter of the esophagus, with the first row between the narrowed gastric mucosa and the esophagus, followed by covering the anastomosis line circularly dissected serous-submucous case.

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