[lat. (ductus) of choledochus a bilious channel + duodenum a duodenum - j-Greek stoma of companies, an opening, pass] — surgery of imposing of an anastomosis between the general bilious channel and a duodenum.
For the first time operation was carried out by B. Ridel in 1888. Internal choledochoduodenostomy T. K oh offered ER in 1894.
Indications: the impassability of di
of steel department of the general bilious channel caused, e.g., a не-удалимым by a stone, a cicatricial stenosis, an injury and when is absent or cannot be used for an anastomosis a gall bladder; inborn choledochal cysts. It is necessary to consider that after choledochoduodenostomy pressure in the general bilious channel considerably decreases that is followed by dysfunction of a gall bladder. Therefore along with this operation carry out a cholecystectomia (see).
narrow general bilious channel, thinning or inflammation of its walls, cicatricial and infiltrative changes of a duodenum.
Distinguish outside (supraduo-denalny) and internal (a ladder - duodenal) choledochoduodenostomy.
For imposing of an outside hole-dokhoduodenostoma usually and swarms:? drive a longitudinal choledochotomy (see) in supraduodenalny department of the general bilious channel 2 — 3 cm long. The section of a front wall of a duodenum of a little smaller length is carried out on its longitudinal axis. Both sections shall be perpendicular to each other that promotes the best gaping anasto-
Mose and provides more bystry emptying of bilious channels from z and [» and with y in and e m about about to and sh e h N about about with about d about r and - mo go. Edges of an anastomosis connect a two-row or one-row noose suture an atraumatic needle small knots outside (see Seams surgical). The abdominal cavity is drained (see Drainage) and layer-by-layer taken in.
By X about ledokhoduodenoanastomoz not only the side sideways, but also the end sideways can be imposed. At the same time the general bilious channel is crossed across over edge of a duodenum. The central end it is anastomosed with a gut on a way the end sideways, and distal — tied up. This operation is technically more difficult, the sizes of an anastomosis at this option are limited to diameter of a channel, it is exposed to scarring and narrowing more often that can promote emergence of the ascending holapgit (see). There are many modifications of outside choledochoduodenostomy providing various directions of cuts of a wall of a duodenum and the general bilious channel for the purpose of prevention of insolvency of the put stitches, reduction of the switched-off part of the general bilious canal (by a partial section of its retroduodenal part) and restrictions of throwing of contents of a gut to bilious canals due to formation of valves. One of options of outside choledochoduodenostomy is retroduode-nalny choledochoduodenostomy, at a cut the anastomosis is imposed after a retroduodenal choledochotomy (see). These modifications complicate operation, but do not improve its results and therefore are applied seldom.
At internal (transduodenal) choledochoduodenostomy after mobilization of a duodenum its front wall is opened in a projection of a faterov of a nipple (a big nipple of a duodenum, T.). For specification of its localization metal or is better the plastic probe enter through previously imposed supraduodenalny holedokhotomi-chesky opening. The end of the probe is well probed through a front wall of a duodenum. P a donkey of a duodenotomy (see the Duodenum, operations) but to the probe cut a back wall of a duodenum and a front wall of the general bilious channel, create holedokhoduodenoanasto-moz, sewing dissect edges of a mucous membrane of the general bilious channel and a mucous membrane of a duodenum. At the driven stones of terminal department of the general bilious channel cut walls of a gut and a channel over a stone throughout 1,5 — 2 cm. After removal of a concrement and audit of bilious channels sew among themselves dissect edges of a mucous membrane of a channel and gut separate seams an atraumatic needle. Operation is finished with sewing up of a wound of a front wall of a duodenum a two-row seam and a choledochostomy (see) .
Internal choledochoduodenostomy is technically difficult operation, certain skills and experience of the surgeon are necessary for performance a cut in addition to special tools. The impossibility of imposing of an anastomosis of big length, danger of heavy complications (pancreatitis, retroperitoneal phlegmon, bilious and duodenal fistulas) limit indications to this intervention.
Complications after outside choledochoduodenostomy meet seldom. The good long-term results are observed for many years at 80 — 95% of patients.
See also Bilious channels. Bibliography: Vinogradov V. V.,
In and sh N e in with to and y A. A. and To about the h and and-III in and l and V. I. Biliodigestivnye an anastomosis, M., 1972; Ryneysky S. V. and Morozov Yu. I. Choledochoduodenostomy, M., 1968; To about with h e of T. Ein Fall von Choledocho-Duodenostomia interna wegen Gallenstein, KorrespBl. schweiz. Arz., Bd 25, S. 193, 1895; Riedel,
Erfahrungen iiber die Gallensteinkrankheit mit und ohne Icterus, V., 1892.
O. B. Milonov.