CHOLECYSTOGASTROSTOMY (Greek chole bile + kystis a bubble + gaster a stomach + stoma of companies, an opening, pass) — imposing of an anastomosis between a gall bladder and a stomach.
The cholecystogastrostomy is one of options bilpodigestiv-
the ny anastomosis which is carrying out bypass removal of bile from extrahepatic bilious channels in went. - kish. a path when natural outflow of bile from the general channel in a duodenum is broken (see the Hepaticoduodenostomy, Gepa-toduodenostomiya, Holedokhoduodeno-stomi I, Holetsis a toduodenostomiya,
For the first time a cholecystogastrostomy made in 1892 Mr. of Gershuni (V. Ger-suny) concerning the restrained stone of a faterov of a nipple (a big nipple of a duodenum, T.). In 1898 it was executed by S. I. Spasokukotsky at a pancreatic cancer.
An indispensable condition for imposing holetsistogastroanastomo-for — good passability of vesical and hepatic channels (see. Bilious channels). Negative side of a cholecystogastrostomy is receipt of a significant amount of bile in a stomach that often is followed by painful heartburn, the repeating vomiting, development of heavy gastritis. In a crust, time the cholecystogastrostomy is used seldom, by hl. obr. at impassability of terminal department of the general bilious channel because of a tumor when it is impossible to execute operation of a holetsistoenterosto-miya. The last is more reasonable in similar cases since at the same time the anastomosis continues to function also after germination and a prelum a tumor of a duodenum. At permanent obstruction of the general bilious channel concrements make radical operations — a papillosfinktero-tomiya and transduodenal choledochoduodenostomy.
For simplification of performance of a cholecystogastrostomy the stomach before intervention is exempted from contents by means of a stylet. After a laparotomy (see) in right hypochondrium and audits of bilious ways and pancreas antral department (lesser cul-de-sac, T.) stomach easily without tension pull together with considerably the increased gall bladder. The last is punktirut a trocar or a thick needle and exempted from bile. The anastomosis a side sideways is imposed between a bottom of a gall bladder and a front wall of a stomach
3 — 4 cm higher than the gatekeeper. After imposing of a back row of serous and muscular seams the gleam of both bodies is opened, delete contents by means of a suction and sew mucous membranes. Then take in a front wall of an anastomosis also two-row seams. Length of an anastomosis shall be not less than 4 cm that the gastric contents thrown in bilious ways easily arrived back. The abdominal cavity is drained and taken in layer-by-layer. V. V. Vinogradov, imposing holetsistogastroanastomoz, applies a mechanical seam by means of the device G1 KS-25 (see Staplers) that simplifies performance of operation and reduces number of complications.
In the postoperative period evacuation of bile from a gall bladder by means of the stylet entered through a nose and which is carried out through an anastomosis is reasonable.
The result of operation depends on character of a basic disease. At not tumoral defeats it is quite favorable though at a part of patients gastritis develops; at malignant tumors — krat-kovremen.
Bibliography: In innovation centers V. V., Vishnevsky V. A. and To about the h and and sh in and l and
V. I. Biliodigestivnye an anastomosis, M., 1972; And shch e N to about I. N. Operations on the bilious ways and a liver, Kiev, 1966; Operational surgery, under the editorship of I. Littmann, the lane with Wenger., Budapest, 1982; About the h to and
A. D N. Cholelithiasis, cholecystitis and their surgical treatment, M., 1949; Smirnov. B. Surgeries on the bilious ways, L., 1974.
O. B. Milonov.