GEPATODUODENOSTOMIYA (grech, hepar, hepat[os] liver + lat. duodenum a duodenum + Greek stoma of companies, an opening) — operation of imposing of an anastomosis between an intra hepatic bilious channel and a duodenum, option of a biliodigestivny anastomosis.
Operation is applied when extrahepatic bilious channels cannot be used for an anastomosis with a duodenum (hepaticoduodenostomy).
The idea of a possibility of use of intra hepatic bilious channels for an anastomosis with various departments went. - kish. a path belongs to Baudouin (Baudoin, 1886) and to Langenbukh (Page J. A. Langenbuch, 1887). Antegrade G.'s technique developed in 1930 Getz (O. Goetze).
Removal of bile at G. can be antegrade — from the hepatic channels allocated in portal fissures, and retrograde — by anastamosing of a duodenum with the wound surface of the site of a liver after its resection without special allocation of the expanded bilious course (actually a gepatoduodenostomiya), with the allocated expanded bilious course, with the segmented bilious course revealed after a section of a parenchyma of the corresponding segment of a liver with subcapsular bilious channels at their expansion (gepatokholangioduodenostomiya).
Indication to G. serve the mechanical jaundice caused by a high cicatricial stricture of the general hepatic channel, a prelum its inflammatory infiltrate or a malignant tumor of bilious ways or the next bodies. The anastomosis with a duodenum is more physiologic, than with a jejunum, but technically more difficult and is not always feasible therefore at the specified situations the gepatoyeyunostomiya can be carried out.
Contraindications to G. serve extremely serious general condition of the patient (in these cases apply operation of outside removal of bile — a gepatokholangiostomiya), duodenostaz, inflammatory or cicatricial changes of a wall of a duodenum (in these cases make imposing of an anastomosis with other departments went. - kish. path: gepatogastro-or gepatoyeyunostomiya).
Preoperative training of the patient to operation G. same, as at other operations on the bilious ways and a duodenum (see. Gall bladder, operations).
Technology of operation
Abdominal cavity open in right hypochondrium. During the imposing of an anastomosis with the main hepatic channels they are allocated in portal fissures. Peripheral subcapsular channels can be used for removal of bile at their expansion. The anastomosis with intra hepatic channels is imposed on a drainage tube, edges plays a role and in removal of bile, and in formation of an anastomosis (fig). The anastomosis is usually imposed a one-row suture silk or synthetic threads on an atraumatic needle. Operation is finished with leading of a drainage to subhepatic space which is deleted in 7 — 9 days after operation. G.'s efficiency, as well as other biliodigestivny anastomosis, substantially depends on width of an anastomosis.
Complications: parenchymatous bleeding, purulent fusion of a liver, intra hepatic abscesses, focal necroses of a liver, the ascending cholangitis, insolvency of seams of an anastomosis, etc.
Results of operation: the postoperative lethality at an anastomosis with intra hepatic channels makes apprx. 25%. G. given about the long-term results are poor and contradictory in connection with a rarity of this operation. At malignant diseases average life expectancy after G. makes 4 — 4,5 months (on the Guru and Ebert), at high-quality defeats — the good and satisfactory long-term results make apprx. 70%.
Bibliography: Vinogradov V. V., Vishnevsky V. A. and Kochiashvili V. I. Biliodigestivnye anastomosis, Surgery, No. 5, page 18, 1973, bibliogr.; Kochiashvili V. I. The atlas of surgical interventions on the bilious ways, M., 1971; Fedorov S. P. Gallstones and surgery of bilious ways, L. — M, 1934; Goor D.A. Ebert P. A. Anomalies of the billiary tree, Arch. Surg., v. 104, p. 302, 1972, bibliogr.
G. B. Katkovsky, 3. A. Topchiashvili.