From Big Medical Encyclopedia

DEMUCOSATION (Latin the de-prefix extraction, destruction + [tunica] of mucosa a mucous membrane) — removal of a part of a mucous membrane of this or that hollow body went. - kish. path. Use as one of elements of various operations. Apply several types of this operation: 1) Of piloroantralny department of a stomach at its resection in modification «for switching off» concerning trudnoudalimy low-sited duodenal ulcers; 2) Of antral department of a stomach in combination with vagisection and a pyloroplasty as an organ-preserving way of treatment of a peptic ulcer; 3) Of the loop of a small bowel which is switched off from digestion as one of stages of surgical treatment of labelloid fistulas; 4) Of a gall bladder; 5) At some rectum operations.

H. Finsterer in 1918 spoke a possibility of removal of a mucous membrane of the left part of antral department of a stomach at its resection «for switching off» low-sited trudnoudalimy ulcers of a duodenum. Such operation was for the first time executed by R. Willmanns in 1926. The same reception was used by K. P. Sapozhkov (1951) during the closing of a stump of a duodenum on a so-called way of a cuff, and also at a resection of a stomach «for switching off».

During the performance of a resection of a stomach with preservation of the gatekeeper G. S. Toprover (1966) and Y. Nakao et al. (1968) for reduction of a possibility of development of a round ulcer in addition made D. of the left 2 cm of prepyloric department of a stomach. Kerk (R. The m of Kirk, 1972) applied D. of all antral department without resection of a stomach, combining this intervention with a pyloroplasty across Geyneka — to Mikulich (see. Pyloroplasty ) and vagisection (see).

Of the switched-off loop of the small bowel bearing labelloid fistula were developed by K. P. Sapozhkov (1922). Removal of a mucous membrane, according to the author, shall lead to an obliteration of the switched-off intestinal loop. This operation is applied when there are contraindications to a resection of this loop of a gut in the intra belly way.

Of a gall bladder — a mucoclasis across Pribram — apply according to very limited indications at cholecystectomias (see) when massive cicatricial and commissural process in circles of a gall bladder or its intra hepatic arrangement create big risk of damage of surrounding bodies in the course of allocation of a bubble. At the same time tie up a vesical channel, excise as far as possible a wall of a gall bladder, and from the rest scrape out it a mucous membrane. Operation is finished with leading of a tampon and drainage to a bed of a gall bladder.

At a disease of Girshsprunga apply operation to Soava — Lenyushkina — a resection of the aganglionarny site of a large intestine with bringing down of a proximal part and its drawing through a demukozirovanny distal part of a rectum.

At nonspecific ulcer colitis sometimes make similar operation — removal of all large intestine and an upper third of a rectum with excision of a mucous membrane of its lower part and carrying out an ileal gut through the remained muscular tube of a rectum with a podshivaniye of the last to skin around an anus [Ravitch, 1948].

At diffusion to a polypose of direct and thick guts make a subtotal colectomy with imposing of an ileorektalny anastomosis after a preliminary scraping an acute spoon of a mucous membrane of a rectum together with polyps [R. Oppolzer, 1964].

Whitehead's operation which is seldom applied at hemorrhoids — circular excision of a mucous membrane of the bottom of a rectum together with internal hemorrhoidal nodes and the subsequent podshivaniye of the reduced mucous membrane to perianal skin — is also based on D. of a distal piece of a rectum.

See also Stomach, operations ; Gall bladder , operations; Intestines , operations.

Bibliography: Agafonov A. A. Further development of layer-by-layer operative measures on a wall of a stomach, Klin, hir., No. 3, page 8, 1972, bibliogr.; Boots To. Item Demucosatio intestini as operational method of treatment of some types of intestinal fistulas, Vestn, hir. and frontier. Region, t. 2, book 4-6, page 135, 1922; Sidorenko V. I. ipantsy-r e in Yu. M. Possibilities of use of demucosation in gastric surgery, Surgery, No. 3, page 124, 1975, bibliogr.; Finsterer H. Ausgedehnte Magenre-sektion bei Ulcus (duodeni) statt der einfaChen Duodenalresektion bzw. Pylorusaus-schaltung, Zbl. Chir., S. 434, 1918; Grosz G. R. Defeating the difficult duodenal dissection, Amer. J. Surg., v. 124, p. 115, 1972, bibliogr.; Kirk R. M. a. Sussman T. Vagotomy and mucosal antrectomy in the elective treatment of duodenal ulcers, ibid., v. 123, p. 323, 1972. bibliogr.; Whitehead W. Surgical treatment of hemorrhoids, Brit. med. J., p. 148, 188,2.

G. A. Pokrovsky.