CHOLECYSTODUODENOSTOMY

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CHOLECYSTODUODENOSTOMY

(Greek chole bile + kystis a bubble - f - lat. duodenum a duodenum + Greek stoma of companies, an opening, pass) — operation of creation of an anastomosis between a gall bladder and a duodenum.

It is for the first time offered and carried out in 1889 Mr. of L. F. Terrier for the purpose of ensuring outflow of bile at the impassability of the general bilious channel (see. Bilious channels) caused by cancer of a head of a pancreas.

In a crust, time operation is applied at impassability of terminal department of the general bilious channel of not tumoral character: vos

a palitelny stenosis of a faterov of a nipple (see), pancreatitis (see), a trudnouda-limy stone (see Cholelithiasis), and also in cases when it is impossible to execute supraduodenal-ny choledochoduodenostomy (see). Indispensable condition for performance of a cholecystoduodenostomy is full passability of vesical and hepatic channels. At tumors of a pankreatoduodenalny zone operation is inexpedient since in case of germination by a tumor of a duodenum the anastomosis ceases to function.

Technically a cholecystoduodenostomy more difficult surgery, than a cholecystogastrostomy (see). However it is more preferable to carry out a cholecystoduodenostomy as bile at the same time comes to the same department went. - kish. path, as under natural conditions.

After a laparotomy (see) in right the hypochondrium is chosen by the place,


Fig. The diagrammatic representation came a chitelny stage of imposing of a holetsisto-duodenoanastomoz: / — front number of serous and muscular seams; 2 — a gall bladder; 3 — the general bilious channel; 4 — a duodenum.

where usually increased gall bladder most closer prilezhit to a duodenum. Put noose serous and muscular sutures throughout 3 — 4 cm between a bottom of a gall bladder and a duodenum. Then open gleams of a gut and a gall bladder and put a continuous catgut suture on their walls, taking both serous, and mucous covers (see. Intestinal seam). Imposing of an anastomosis is finished with a front number of serous and muscular seams (fig). The abdominal cavity is drained (see Drainage) and taken in layer-by-layer. Postoperative maintaining the patient same, as at a gall bladder operations (see. Postoperative period). The drainage is deleted on 4 — the 5th day, seams are removed for the 10th day.

Results of operation depend on character of a basic disease. At not tumoral processes they are quite favorable. However because of infection of a wall of a gall bladder and its sclerous changes in the late postoperative period there is an impassability of a vesical channel. Therefore recently this intervention is carried out seldom, giving preference to choledochoduodenostomy (see).

See also Duodenum, operations; Gall bladder, operations; Cholecystogastrostomy. Bibliography: See bibliogr. to St. Cholecystogastrostomy. O. B. Milonov.

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