HOLETsISTOENTEROSTOMYYa [Greek chole bile + kystis bubble + ep-teron gut + stoma of companies, opening, pass; synonym: operation Monastyr
sky, holetsistoyeyunoanastomoz, cholecystojejunostomy] — operation of creation of an anastomosis between a gall bladder and a jejunum.
For the first time the holetsistoenterostomiya at cancer of a head of a pancreas was executed in 1887 by N. D. Monastyrsky. In 1902 P. A. Herzen suggested to use the At-shaped anastomosis in these cases, and P. D. Solovov in 1906 carried out a pozadiobodochny holetsistoenterostomiya.
Holetsistoenterostomiya is palliative intervention,
a cut make for elimination of the obturatsionny jaundice caused by the impassability of terminal department of the general bilious channel caused by a nonresectable tumor (see. Bilious channels), cancer of a faterov of a nipple (big nipple of a duodenum, T.) or heads of a pancreas. Less often it is carried out concerning the indurative pancreatitis (see) leading to a prelum of the general bilious channel or in connection with extended (more than 3 cm) cicatricial structure of the last.
Operation allows to create a bi-liodigestivny anastomosis and when it is impossible to execute a cholecystogastrostomy (see) or a cholecystoduodenostomy (see), napr, at a pericholecystitis, a gastropexy and a duodenum hems, gastroduodenal impassability, others patol. changes of these bodies. It provides removal of bile in intestines and does not lead to disturbance of gastric digestion unlike a cholecystogastrostomy. A lack of operation is the possibility of scarring and an obliteration of an anastomosis and a vesical channel owing to infection of bilious ways that leads to a recurrence of jaundice.
Good passability of vesical and hepatic channels, lack of inflammatory and cicatricial changes of a gall bladder is necessary for normal functioning of an anastomosis. The anastomosis shall be wide (not less than 4 cm) that at an inevitable reflux of intestinal contents it was easily brought out of bilious ways back to a gut. Formation of an anastomosis is facilitated by the fact that the gall bladder in these cases is considerably increased in razkhme-ra. It is reasonable to punktirovat previously a gall bladder (see the Cholecystostomy). For the prevention of the ascending infection of bilious ways during the imposing of an anasta-moz the loop of a jejunum is switched off on Brown's way or on a way of Ru.
At switching off of a segment of a jejunum on Brown's way after Mia's paw-roto (see) on a loop of a jejunum at distance of 50 — 60 cm from a duo-denalno-eyunalnoy of a fold impose two-row seams an inter-intestinal anastomosis a side sideways between its bringing and taking away departments (see Enteroenteroanastomoz). For the prevention of throwing of contents of a gut the bringing loop of a jejunum is tied up a silk ligature, to-ruyu covered from above with gray and serous seams on perimeter of a gut. After that the switched-off loop of a jejunum is brought ahead of or behind a cross colon (in the latter case through the opening made in a mesentery to the right of an average colonic artery) to a gall bladder. For creation of a holetsistoen-teroanastomoz at first impose a back row of serous and muscular seams on a longitudinal axis of a gut and a lateral axis of a gall bladder, then open with cuts, identical on length, a gleam of both bodies and sew edges of cuts of walls of a gall bladder and a jejunum a continuous catgut suture then impose the second row of gray and serous seams on a front wall of an anastomosis (fig).
Fig. The diagrammatic representation of a gall bladder, extrahepatic bilious channels and a loop of the jejunum which is switched off on Brown's way at a holetsistoenterosto-miya: 1 — a gall bladder; 2 — an anastomosis between a bottom of a gall bladder and a loop of a jejunum at the time of imposing of the second row of gray and serous seams; 3 — gray and serous stitches are put on the alloyed bringing loop of a jejunum; 4 — enteroenteroanastomoz,
At connection of a gall bladder with a loop of the jejunum which is switched off on a way of Ru (see fig. 4, 9 to the Art. of Biljrot operation, t. 3, Art. 133), the loop of a jejunum is carried out ahead of a cross colon. The anastomosis between a gall bladder and the switched-off department of a jejunum is created as well as at the first way.
During imposing of an anastomosis the surgery field is delimited gauze napkins, and the streaming contents of a gut, blood and bile constantly evacuate by means of a suction machine. Operation is finished with drainage of an abdominal cavity a rubber tube (see Drainage). At sewing up of a wound of a front abdominal wall stitches should be put often, with occupation of the big site of fabrics, to carry out a careful hemostasis, considering that at these patients tendency to bleeding and suppuration of a wound is noted.
Holetsistoenterostomiya is rather easily transferred by patients even with the expressed mechanical jaundice. Already next day at them the painful itch disappears, gradually, though slowly, jaundice decreases. The long-term results of operation depend on a basic disease.
Bibliography: Gertsenp. A. K to a question of the equipment of a holetsistoenterostomiya, Russian hir. obozr., t. 1, book 1, page 32, 1903; Matyushin I. F. Guide to operational surgery, Gorky, 1982; Operational surgery, under the editorship of I. Littmann, the lane with Wenger., Budapest, 1982; Smirnov E. V. Surgeries on the bilious ways, L., 1974. O. B. Milonov.