Novosti
Khirurgii

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Year 2020 Vol. 28 No 4

EXCHANGE OF EXPERIENCE

V.I. RUSIN, K.YE. RUMIANTSEV, V.V. RUSIN, V.V. MASHURA

GASTROJEJUNODUODENOSTOMY IN PROPHYLAXIS AND TREATMENT OF DUODENAL STUMP LEAKAGE AFTER PREVIOUS DISTAL GASTRECTOMY DUE TO PEPTIC ULCER

Uzhhorod National University, Uzhhorod,
Ukraine

Objective. To evaluate the clinical efficacy of gastrojejunoduodenostomy for the repair of a «difficult» or incompetent duodenal stump after gastrectomy.
Methods. The experience of gastrojejunoduodenostomy application after distal gastrectomy for peptic ulcer is represented in the paper. Gastroenoduodenostomy was performed using a small intestine loop, isolated according to Roux, on which a gastrojejunoanastomosis was first applied according to the “end-to-end” or “side-to-side” type, and then duodenojejunostomy “end of the duodenal stump-in-side Roux” was performed. 5 consequent clinical cases of the gastrojejunostomy application for the period of 2018-2019 are described. All patients were male, aged 51 to 68 years. In 3 patients gastrojejunoduodenostomy was performed after the previous operation, and in 2 patients – initially, due to the impossibility of the duodenal stump primary closure.
Results. In the early postoperative period complications occurred in 2 patients: bilateral deep vein thrombosis of the lower limbs and postoperative wound suppuration. The patient with suppuration died due to progression of chronic heart failure 27 days after surgery.
Conclusion. The positive aspects of the gastrojejunoduodenostomy are: universality – the possibility of application both in case of «difficult» stump, and in case of its incompetence treatment; simplicity – the surgeon only cuts and creates anastomoses without any plasty or cutouts, etc.; applicability for «low» and juxtapapillary ulcers – suturing of the small intestine to the stump which is possible even along 1 mm wide edge of the mucous membrane; applicability in the absence of the anterior wall of the duodenum – after previously applied Finney and Jaboulay pyloroplasty, after the Judd’ excision of the perforated ulcer; plastic properties – the use of a well-perfused loop of the small intestine to close a defect with inflamed edges is akin to a skin flap transplantion onto a wound; decompression of the duodenum; reduodenization of food passage.

Keywords: peptic ulcer of duodenum, distal gastrectomy, duodenal stump leakage, gastrojejunoduodenostomy; Roux-en-Y loop
p. 460-469 of the original issue
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Address for correspondence:
88018, Ukraine,
Uzhhorod,
Kapushanskaya str., 22,
Uzhhorod National University,
The Department of Surgical Diseases.
Tel. +380 (50) 950-95-84,
e-mail: roff75@gmail.com,
Rumiantsev Kostiantyn E.
Information about the authors:
Rusyn Vasyl I., MD, Professor of the Department of Surgical Diseases, Uzhhorod National University, Uzhhorod, Ukraine.
https://orcid.org/0000-0001-5688-9951
Rumiantsev Kostiantyn E., MD, Professor of the Department of Surgical Diseases, Uzhhorod National University, Uzhhorod, Ukraine.
https://orcid.org/0000-0002-8154-0601
Rusyn Vasyl V., MD, Professor of the Department of Surgical Diseases, Uzhhorod National University, Uzhhorod, Ukraine.
https://orcid.org/0000-0002-0794-6777
Mashura Valerii V., PhD, Assistant of the Department of Surgical Diseases, Uzhhorod National University, Uzhhorod, Ukraine.
https://orcid.org/0000-0001-9066-7228
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