GASTRODUODENOSTOMY

From Big Medical Encyclopedia

GASTRODUODENOSTOMY (Greek gaster stomach + lat. duodenum a duodenum + grech, stoma of companies, an opening, pass) — operation of creation of an artificial anastomosis between a stomach and a duodenum. Development of this operation and its justification are connected with unsatisfactory results of surgical treatment of a peptic ulcer by a gastroenterostomy, after a cut round ulcers in the loop of a jejunum anastomosed with a stomach quite often develop. Emergence of round ulcers was explained with impracticality of a mucous membrane of a jejunum to the acid gastric contents arriving through an anastomosis in this connection surgeons aimed to use for an anastomosis higher departments of a jejunum counting on their big resistance to acid contents.

the Scheme of a gastroduodenostomy across Finney. Creation of a big anastomosis between a stomach and a duodenum at the crossed and nonfunctioning gatekeeper: and — the horseshoe section with crossing of the gatekeeper opened a gleam of peloric department of a stomach and the duodenum hemmed to it; — the continuous catgut suture on a mucous membrane of a back wall of peloric department of a stomach and a duodenum passing to a front wall of the created anastomosis is put; in — the front wall is sewn up, operation is complete; 1 — a duodenum; 2 — the gatekeeper; 3 — a stomach

Belflera (A. Wolfler, 1881) replaced a gastroenterostomy on a long loop the pozadiobodochny gastroenterostomy on a short loop on Gakkera (V. Hacker, 1885) which in essence a little influenced the frequency of development of round ulcers. In this regard certain surgeons began to make at a peptic ulcer the highest gastroenterostomy — a gastroduodenostomy. For the first time G. executed and described Zhabule (1892) therefore in literature this operation meets also under the name «Zhabule's operation». It consists in imposing of an anastomosis a side sideways between a front wall of prepyloric department of a stomach (closer to big curvature) and the descending department of a duodenum, previously a little mobilized. In the subsequent Finney (J. Finney, 1902) offered modification of this operation — G.'s combination to a pyloroplasty, edges is the highest gastroenterostomy at treatment of a peptic ulcer.

Technology of operation

After an ulotomy and mobilization of a duodenum and the gatekeeper, beginning from a peloric corner, the front wall of a duodenum serous and muscular seams is hemmed to a front wall of peloric department of a stomach along its big curvature throughout 5 — 6 cm. Further open with the horseshoe section which is bending around the line of seams, a little otstupya from them on a front wall gleams of a stomach and duodenum with crossing of the gatekeeper. The mucous membrane of a stomach is sewed throughout a horseshoe section with a mucous membrane of a duodenum through all layers a continuous catgut suture with the subsequent peritonization serous and muscular seams on all line of the first row of seams. As a result, unlike an initial technique of a gastroduodenostomy across Zhabula, create one big anastomosis between a stomach and a duodenum at the crossed and nonfunctioning gatekeeper (fig).

More often this operation is called a pyloroplasty across Finney as at it G. is made in combination with a pylorotomy.

Across Finney and across Zhabula it is applied at modern methods of treatment peptic ulcer (see) in combination with vagisection (see). Without simultaneous vagisection at a peptic ulcer these operations are inefficient since they in most cases do not lead to healing of an ulcer.

See also Gastroenterostomy .


Bibliography: Pantsyrev Yu. M., Cher-nyakevich S.A. idivilinav. Ya. The draining operations in combination with vagisection at treatment piloro-duodenal-nogo a stenosis, Surgery, No. 7, page 37, 1973; Shalimov A. A. and Saenko of V. F. Hirurgiya of a stomach and duodenum, Kiev, 1972; Finney J. M. T. of A new method of pyloroplasty, Bull. Johns Hopk. Hosp., V. 13, p. 155, 1902; J a b about

u-1 an at, La gastro-ent6rostomie, la jejuno-duod6nostomie, la resection du pylore, Arch. prov. Chir. (Paris), t. 1, p. 1, 551, 1892.

B. S. Rozanov.

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