DUODENOJEJUNOSTOMY

From Big Medical Encyclopedia

DUODENOJEJUNOSTOMY (Latin duodenum a duodenum + jejunum a jejunum + grech, stoma of companies, an opening) — operation of imposing of an anastomosis between duodenal and a jejunum. Apply at the duodenostaza caused by the mechanical or functional reasons. The principle of operation was offered by P. S. Albrecht in 1899 and J. Finney in 1906, is for the first time executed by A. L. Stavely in 1908 Duval (P. Duval, 1924) suggested to impose an anastomosis with the descending part of a duodenum that yielded bad results because of insufficient drainage of underlying departments of a gut. The technique of operation on Boppa is more proved (Boppe, 1928), at a cut an anastomosis the jejunum connects to the lower horizontal part of a duodenum. This modification of operation is applied in a wedge, practice.

Indications

Indications: children have inborn malformations (stenoses of a duodenum or initial department of a jejunum, a ring-shaped pancreas, the incomplete turn of intestines, arteriomesenteric impassability) in the absence of effect of conservative treatment which far came duodenostaz with development of cicatricial narrowings of a gut; adults have duodenostaza of various origin and the acquired stenoses of distal departments of a duodenum and initial departments of a jejunum.

In pediatric practice at inborn stenoses of a duodenum the greatest distribution was gained by two modifications of D.: a) a lobby behind a cross colon; b) a lobby ahead of a cross colon.

Technology of operation

Fig. 1. The scheme of a front duodenojejunostomy behind a cross colon. Imposing of a duodenoyeyunoanastomoz a side sideways (a dotted line — lines of a section): and — a seam of a front wall of an anastomosis between duodenal and lean guts; — gleams of guts are opened (stitching on a back wall of an anastomosis, the seam of a back wall of an anastomosis is visible at the left); in — stitching of a front wall of an anastomosis; 1 — a cross colon; 2 — a duodenum; 3 — a jejunum.

Front D. behind a cross colon (fig. 1) is shown at impassability of a duodenum or initial department of a jejunum. Allocate expanded duodenal and a jejunum distalny a stenosis. In the avascular site open a mesentery of a cross colon, in a window of a mesentery stick out an expanded lower horizontal part of a duodenum. Impose an isoperistaltic anastomosis a side sideways between the lower horizontal part a duodenal and initial loop of a jejunum of a stenosis 10 — 12 cm lower than the place. The mesentery of a cross colon is fixed on a duodenum above an anastomosis.

Front D. ahead of a cross colon is shown at stenoses of a vertical part of a duodenum. After audit of an abdominal cavity the initial loop of a jejunum is carried out ahead of a colon. The anastomosis is imposed between expanded department of a duodenum and an initial part of a jejunum is 30 — 35 cm lower than duodenal leanly intestinal bend (flexura duodenojejunalis); then impose additional enteroenteroanastomoz.

Fig. 2. Scheme of a Y-shaped duodenojejunostomy: 1 — a stomach; 2 — a duodenum; 3 — a jejunum; 4 — duodenoyeyunoanastomoz.

At duodenostaza the anastomosis of a jejunum with the lower horizontal part of a duodenum not always yields good results. A. Bergeret in 1944 offered at duodenostaza several options D. with use of the lower horizontal and vertical part of a duodenum. The duodenum is crossed from a duodenoyeyunalny bend to the right. Removal lower horizontal and parts of a vertical duodenum of branches is possible. A continuity of a digestive tract recover an anastomosis a side sideways or the end in the end. E. V. Smirnov (1969) at hron, duodenostaza considers imposing of a Y-shaped duodenoyeyunoanastomoz with the most actively peristaltiruyushchy part of a duodenum (fig. 2) most expedient.

At inborn malformations the result of operation depends on weight of a condition of the patient before operation.

Complications

Insolvency of seams of an anastomosis, peritonitis, impassability of again imposed anastomosis, phlegmon of peripancreatic cellulose, etc.

At hron, duodenostaza of a functional origin operation D. does not bring success. Operation gives the best effect at the duodenostaza caused by the mechanical reasons.

See also Duodenum, operations .


Bibliography: Mirzayev A. P. Duodenal staz, L., 1976, bibliogr.; H and-palkov P. N. K of surgery of a chronic duodenostaz, Vestn, hir., t. 91, No. 10, page 43, 1963; Rudakova T. A. Formation of an anastomosis between duodenal and a jejunum, in book: Operational hir. it is put. age, under the editorship of E. M. Margo-rina, page 313, L., 1967; Smirnov. B. Surgical treatment of a duodenal staz, Vestn, hir., t. 102, No. 2, page 3, 1969; Shalimov A. A. and Saenko of V. F. Hirurgiya of a stomach and duodenum, page 337, Kiev, 1972, bibliogr.; D and-val P., Roux J. Page of et Vyos1yoge H. Etudes medico-radio-chirurgicales sur le duodenum, P., 1924; Hess W. Erkrankungen der Gallenwege und des Pankreas, Stuttgart, 1961; P u r a n i k S. R., K e i s e r R. P. a. Gilbert M. G. Arteriomesenteric duodenal compression in children, Amer. J. Surg., v. 124, p. 334, 1972, bibliogr.; Surgery of the stomach and duodenum, ed. by H. N. Harkins a. L. M. Nyhus, Boston, 1969.

V. P. Strekalovsky.

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