Prophylaxis of damage of extrahepatic biliary ducts and pancreatic ducts while performance of gastric resection in accordance to Billroth II method for complicated duodenal ulcers

Objective. To elaborate a method of mobilization and a method of closure of “complex handed” duodenal stump while operating for complicated giant penetrating pyloroduodenal ulcers with the aim to prevent iatrogenic damage of extrahepatic biliary ducts and pancreatic ducts and to improve the results of surgical treatment of this pathology. Materials and metods. In the investigation 46 patients were included, who were operated on for complicated giant penetrating pyloroduodenal ulcers. Giant pyloroduodenal ulcers have had more than 2.5 cm size. The method of duodenal mobilization and the method of suturing of a “complex” duodenal stump were proposed. The method of duodenal mobilization consists of duodenotomy in the zone of a cicatricial-ulcerative transformation and intraintestinal digital upper and anterior stretching towards yourself of all duodenal walls from adhesive process, what includes mobilization of upper-horizontal and of part of descending duodenum portiions, using incision of visceral peritoneum along right and left edges of colon on a distance, sufficient to form its stump without tension. The method of suturing of a “complex” duodenal stump consists of duodenotomy in the affected zone of circular ulcer process. This permits to determine a degree of ulcerative stenosis, to exterritorize the ulcer and after duodenal mobilization, using the above mentioned method, to apply the duodenal mobilized walls for formation of a stump. Application of a one-raw interrupted screw-up sutures permits to distribute the pressure load along all sutures what enhances a mechanical strength of the sutures placed. Results. Average duration of the operation have constituted 136.6 min (95% CI: 125.2; 152.0); a stationary stay - from 7 to 26 bed-days, 15.7 days (95% CI: 13.1; 18.2) at average. Among early postoperative morbidity there were: infection in the wound zone - 2 (4.3%), pneumonia (4.3%), stroke - 1 (2.2%), pulmonary thromboembolism - 1 (2.2%), insufficiency of the duodenal stump sutures - 1 (2.2%) observation. Postoperative mortality have constituted 4.3%, 2 patients died, in 1 (2.2%) pulmonary thromboembolism was the cause of the death, and in 1 (2.2%) - hemorrhagic insult. The duodenal stump sutures insufficiency and extensive serous-fibrinous peritonitis were revealed in the patient on the 6th postoperative day in 1 (2,2%) patient. In 1 year 31 patients were examined: while performing of fibrogastroscopy in 1 (3.2%) patient the ulcer of posterior wall of gastrojejunoanastomosis was revealed, in 7 (22.6%) - superficial gastritis, in 1 (3.2%) - erosive gastritis of gastric stump. Conclusion. The proposed procedure for duodenal mobilization and the method of the duodenal stump formation in a complicated giant circular pyloroduodenal ulcer permits to minimize a possibility of the stump sutures insufficiency occurrence as well as the prevention of iatrogenic damage of biliary and pancreatic ducts, involved in the ulcer infiltrate, injury, and may be recommended for application in clinical practice. Special attention must be drawn to duodenal decompression in postoperative period and to intestinal stimulation.

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Surgical treatment of peripheral hepatic cholangiocarcinoma with a visceral vein invasion

Klinicheskaia khirurgiia ◽

10.26779/2522-1396.2020.7-8.03 ◽

2020 ◽

Vol 87 (7-8) ◽

pp. 3-9

Author(s):

О. Yu. Usenko ◽

О. V. Hrynenko ◽

А. І. Zhylenko ◽

О. О. Popov ◽

А. V. Husiev ◽

...

Keyword(s):

Surgical Treatment ◽

Hepatic Resection ◽

Comparison Group ◽

Postoperative Mortality ◽

Late Results ◽

Peripheral Cholangiocarcinoma ◽

Group A ◽

Comparative Group ◽

Biliary Ducts ◽

Clinically Significant

Objective. To estimate the immediate and late results of surgical treatment in patients, suffering peripheral cholangiocarcinoma with invasion of visceral vein. Маterials and methods. Retrospective analysis was accomplished for surgical treatment of 84 patients, suffering peripheral cholangiocarcinoma, in whom radical operations were performed in Department of Transplantation and Hepatic Surgery of Shalimov National Istitute of Surgery and Transplantology in a period from Jan. 2004 tо Dec. 2018 yrs. The investigated group consisted of 28 patients, to whom hepatic resection with simultant resection and plasty of visceral veins for tumoral vascular invasion was performed. Into comparison group 56 patients were included, in whom hepatic resection was not accompanied with vascular resection. Results. Trustworthy differences were absent between groups in accordance to following indices: the patients’ age (p=0.16-0.7), gender (p=0.3), physical status (p=0.36), pre- and postoperative stationary stay (p=0.4). In the investigated group there were performed 14.3% hemihepatectomies, 32.1% extended hemihepatectomies and 53.6% threesectioectomies, and in a comparative one - 57.2% (р ≤ 0.001), 14.3% (р = 0.054) and 21.4% (р = 0.002), accordingly. Simultant intervention on biliary ducts was done in 37.5% patients from investigated group and in 25% patients from comparative group (р = 0.305), the adjacent organs resection - in 14.3 and 12.5% (р = 0.819) patients, accordingly. Clinically significant postoperative complications were observed in 25 and 30.4% (р = 0.262) patients, accordingly. In the investigated group postoperative mortality was absent, while in a comparative one it constituted 3.5%. In the investigated group a 3-years and a 5-years total survival was noted in 47 and 35% patients, accordingly, while in a comparison group - in 49% (р = 0.317) and 38% (р = 0.003) patients, accordingly. In investigated group a 3-years and a 5-years survival without a recurrence was noted in 39 and 28% patients, accordingly, and in a comparative group - in 44% (р = 0.04) and 31% (р=0.002) patients, accordingly. Conclusion. Іnvasion of peripheral cholangiocarcinoma into visceral veins does not constitute a contraindication for operative treatment, if it is conducted in a highly specialized multidisciplinary centre.

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MODERN METHODS OF PREVENTION AND TREATMENT OF COMPLICATIONS OF CERVICAL ESOPHAGO-ORGAN ANASTOMOSIS AT ESOPHAGOPLASTY

Wiadomości Lekarskie ◽

10.36740/wlek202008120 ◽

2020 ◽

Vol 73 (8) ◽

pp. 1696-1699

Author(s):

Volodymyr O. Shaprynskyi ◽

Yevhen V. Shaprynskyi ◽

Mustafa Bassam Hussein ◽

Oleg O. Vorovskyi ◽

Yaroslav V. Karyi ◽

...

Keyword(s):

Operative Treatment ◽

Postoperative Period ◽

Comparison Group ◽

Postoperative Mortality ◽

Diagnostic Algorithm ◽

Main Group ◽

Instrumental Method ◽

Complication Risk ◽

Esophageal Strictures ◽

Bed Days

The aim: To improve the results of operative treatment of esophageal strictures by decreasing the rate of failure and stricture of cervical esophago-organ anastomoses. Materials and methods: There were 45 patients with post-burn corrosive gullet strictures, 17 patients with postoperative corrosive strictures, 10 patients with peptic strictures secondary to reflux-esophagitis, 42 patients with esophageal cancer strictures. The patients were divided into two groups: the comparison group – 55 persons and the main group – 59 persons. Patients of comparison group underwent surgical treatment of esophageal strictures according to classic protocols and standards. In the main group of patients we applied proposed diagnostic algorithm with prediction of complication risk and the designed method of esophago-organ anastomosis formation. Results: The results of operative treatment in patients with esophageal strictures showed the development of early postoperative complications in 59 individuals (51.75 %). In the postoperative period six patients died: four – in the comparison group and two – in the main group. Failure of cervical esophago-organ anastomosis and esophageal strictures occurred in 7 patients (11.86 %) of main group and 20 patients (36.36 %) of the comparison group (p<0.05). Conclusions: Application of method predicting the risk of complications of cervical anastomosis, treatment program and instrumental method of formation anastomosis resulted in reduced incidence of failure and strictures of esophago-organ anastomosis from 36.36 % to 11.86 % (p<0.05); decreased time of hospitalization - from 28.2 ± 1.1 to 21.5 ± 0.5 bed-days (p<0.001), postoperative period - from 20.5 ± 1.1 to 16.1 ± 0.7 bed-days (p<0.01); decreased postoperative mortality - from 7.27 % to 3.39 %.

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The complex treatment of patients with perforated gastroduodenal ulcers

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2018-22(3)-17 ◽

2018 ◽

Vol 22 (3) ◽

pp. 479-484

Author(s):

M.I. Pokydko ◽

T.V. Formanchuk ◽

O.V. Goncharenko ◽

A.M. Formanchuk ◽

V.A. Katsal

Keyword(s):

Gastroduodenal Ulcer ◽

Abdominal Cavity ◽

Postoperative Mortality ◽

Multiple Organ ◽

Integrated Treatment ◽

Gastric Ulcers ◽

Duodenal Ulcers ◽

Gastroduodenal Ulcers ◽

The Moment ◽

Sole Criterion

To improve the immediate results of surgical treatment of patients with perforated gastroduodenal ulcers using minimally invasive correction and an integrated treatment. The results of 253 patients with perforated gastroduodenal ulcers who were treated from 2013 to 2018 were analyzed. Chronic ulcers were found in 82 (32%) cases among all gastric ulcers, acute ones constituted 42 (16%) cases. Chronic duodenal ulcers reached 94 (37%), acute ones constituted 35 (14%). The diagnostic laparoscopy was performed in 13 (5%) patients, in 8 (3%) patients the perforated hole was sutured laparoscopically and in 5 (2%) patients the conversion was performed. Abdominocentesis with preoperative abdominal cavity drainage was carried out in 45(18%) patients. Through this drainage after exudate evacuation 200 ml of dekasan solution was injected. In 119 cultures of abdominal exudates with determinate pathogenic microflora Enterococcus faecalis dominated - 31 patients (26%). Among the postoperative complications the failure of intestinal sutures was observed in 4 (1.5%) patients. Postoperative mortality was 11.5%. Progression of multiple organ failure became the cause of mortality in 17 (59%) patients. Thus, the time from the moment of perforation till the moment of surgery must not be the sole criterion in the choice of method of operative intervention, and it is insufficient as an absolute indicator for the possibility of the radical surgical procedures (gastric resection). Undoubtedly laparoscopic suturing of the perforated gastroduodenal ulcer has advantages over laparotomy.

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Analysis of surgical treatment of duodenal ulcers with multiple combined complications

Technology transfer innovative solutions in medicine ◽

10.21303/2585-6634.2021.002151 ◽

2021 ◽

pp. 10-12

Author(s):

Pavlo Ivanchev ◽

Maxim Bilyachenko ◽

Anton Kurbanov ◽

Oleksii Lissov

Keyword(s):

Surgical Treatment ◽

Postoperative Mortality ◽

Bleeding Complications ◽

Duodenal Ulcers ◽

The Third ◽

Number Of Patients ◽

Group A ◽

Analysis Of Results ◽

Surgical Tactics ◽

Group B

The aim of the research. Analysis of results and development of surgical tactics for the treatment of DU with multiple combined complications. Materials and methods. The results of the analysis of surgical treatment of duodenal ulcers with multiple combined complications (3 and 4 combined complications) for 3 periods are presented: 1st (1983–1995) (group A) – 77 patients, 2nd (2000–2007) years (group B) – 30 patients and 3rd (2008–2020) (group C) – 46 patients. Results. 153 patients (100 %) underwent surgery for complicated duodenal ulcer (DU), of which 130 patients (84.9 %) had a combination of three complications and 23 (15.1 %) had four complications. Bleeding complications were noted in 139 of 153 patients, accounting for 90.8 %, and ulcer perforation in 69 patients, accounting for 45.1 % of all other complications. Based on the obtained data of the analysis, there is a steady tendency to increase the proportion of organ-preserving operations (OPO) by 1.5 times (from 50.7 % to 76.2 %), reducing the number of gastrectomy (GR) by 3 times (from 14.5 % to 4.8 %) and palliative operations (PAL) 3.3 times (from 15.8 % to 4.8 %) with a relatively stable number of performed organ-saving operations (OSO): in group A – 17 (24.6 %) interventions, in group B – 4 (21.1 %), group C – 6 (14.3 %). Conclusions. The use of modern measures of endoscopic hemostasis allowed to operate on patients in the delayed period, and their share from the second period to the third increased 2.8 times. The number of patients who underwent emergency surgery with perforation of the ulcer as one of the complications decreased in the third period compared to the second by 2.6 times, due to the widespread use of PPIs in the conservative treatment of DU. According to the results of the analysis it became known that the chosen active-individualized tactics and developed algorithms for choosing the type of surgery allowed to achieve a stable level of postoperative mortality at 8.3 %.

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On resection of deep duodenal ulcers

Kazan medical journal ◽

10.17816/kazmj71784 ◽

1934 ◽

Vol 30 (2) ◽

pp. 348-348

Author(s):

A. Ciminata

Keyword(s):

Duodenal Ulcer ◽

Anterior Wall ◽

Duodenal Stump ◽

Duodenal Ulcers

The author recommends dissecting the anterior wall of the 12 duodenal ulcer, resecting the crater of the ulcer and then performing atypical closure of the duodenal stump followed by peritonization of the stump with the pancreas and the apex of the omentum.

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Risk factors for rebleeding in patients with peptic ulcer bleeding

Kazan medical journal ◽

10.17816/kmj2020-435 ◽

2020 ◽

Vol 101 (3) ◽

pp. 435-440

Author(s):

M V Valeev ◽

Sh V Timerbulatov

Keyword(s):

Risk Factors ◽

Peptic Ulcer ◽

Postoperative Mortality ◽

Posterior Wall ◽

Ulcer Bleeding ◽

Peptic Ulcer Bleeding ◽

Results Of Treatment ◽

Group 2 ◽

Lesser Curvature ◽

Group 1

Aim. To analyze the results of treatment of patients with ulcerative bleeding, to identify the main risk factors for rebleeding in patients with peptic ulcer bleeding. Methods. A retrospective analysis of the treatment results of 240 patients with acute peptic ulcer bleeding who were hospitalized in the Beloretsk Central District Hospital from 2008 to 2018 was carried out. Patients were divided into two groups: group 1 52 patients with rebleeding, group 2 188 patients in whom rebleeding did not occur. Results. Rebleeding in patients with peptic ulcer was observed in 21.7% of cases. The surgical rate was 22.9% and mortality 6.3%. Based on the obtained data, rebleeding should recognize as a risk factor for death [odds ratio (OR) 68.9; 95% confidence interval (CI) 8.8 to 539.7; p 0.001]. Surgical treatment for rebleeding had unsatisfactory results (postoperative mortality in group 1 26.8%, in group 2 0). Risk factors for rebleeding in peptic ulcer bleeding include localization of the ulcer on the lesser curvature of the stomach (OR=2.37; 95% CI=1.18 to 4.74) and the posterior wall of the duodenum (OR=3.84; 95% CI=1.69 to 8.73), as well as Forrest type IIA ulcer (OR=2.67; 95% CI=1.55 to 6.48). Forrest IIc and III ulcers reduce the risk of rebleeding (OR=0.24; 95% CI=0.10 to 0.56). It was found that a shock index, a decreased level of total protein and red blood cells, and an increasing level of urea have a statistically significant relationship with rebleeding in peptic ulcer bleeding. Conclusion. Rebleeding in patients with peptic ulcer is a serious complication of the disease that significantly increases mortality, and predicting the risk of rebleeding is one of the possible tools that can improve treatment outcomes and reduce mortality.

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Gastro-duodenal ulcers with perforation caused by short-term acetylsalicylic acid ingestion: Case report

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0906282c ◽

2009 ◽

Vol 137 (5-6) ◽

pp. 282-284

Author(s):

Djordje Culafic ◽

Olivera Matejic ◽

Jelena Rudic

Keyword(s):

Acetylsalicylic Acid ◽

Perforated Peptic Ulcer ◽

Posterior Wall ◽

Anterior Wall ◽

Laboratory Findings ◽

Ulcer Case ◽

Duodenal Ulcers ◽

Diffuse Abdominal Pain ◽

Interrupted Suture ◽

Cerebrovascular Insult

Introduction. Acetylsalicylic acid ingestion may cause serious gastrointestinal toxicity, in particular bleeding or perforated peptic ulcer. Case Outline. A 72-year-old male patient presented with diffuse abdominal pain, malaise, and dark stools. Several days before hospitalization, he had cerebrovascular insult and began to use acetylsalicylic acid of 100 mg per day. In physical findings a diffusely painful sensitivity of the abdomen was detected on palpation. Laboratory findings revealed hyposideremic anaemia with inflammatory syndrome. Native abdominal x-ray did not show the presence of pneumoperitoneum. Upper endoscopy of the gastric corpus and antrum revealed several ulcerations 10-11 mm in diameter covered with fibrin, with bleeding ulceration in the angulus region of the lesser gastric curvature. The bulbus was oedematous and hyperaemic with a perforated ulcer on the anterior wall. Upper central laparotomy showed a perforated duodenal bulbus. The posterior wall of the bulbus was normal, while the anterior wall was without scarring. Given the general condition of the patient and local findings, interrupted suture of the ulcer was performed with omentoplasty. Postoperative course was uneventful. A peroral diet was initiated on the 4th postoperative day, and the patient was discharged on the 8th postoperative day. Conclusion. Elderly people who use acetylsalicylic acid in prophylaxis should take it in lower doses, with proton pump inhibitors, especially during the first two months.

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594 HAND-SEWN CERVICAL ESOPHAGOGASTRIC ANASTOMOSIS AFTER ESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doab052.594 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Isao Nozaki ◽

Shinji Hato ◽

Yoshihiro Mikuriya ◽

Ryoji Ochiai ◽

Naruyuki Kobayashi ◽

...

Keyword(s):

Gastric Tube ◽

Anastomotic Stricture ◽

Balloon Dilation ◽

Postoperative Mortality ◽

Single Layer ◽

Cost Effective ◽

Posterior Wall ◽

Esophagogastric Anastomosis ◽

Complication Rates ◽

Cervical Esophagogastric Anastomosis

Abstract Successful anastomosis is essential in esophagogastrectomy. Staplers are more popularly applied for the anastomosis. However, a hand-sewn anastomosis is a basic and cost-effective method. Herein, we introduce our technical tips of all hand-sewn cervical esophagogastric anastomosis. Methods Step 1: A 6 cm gastric tube is created and pulled up through the posterior mediastinal route. Step 2: A single layer Gambee sutures are used to approximate the cervical esophagus and the posterior wall of the gastric tube in end-to-side fashion. Step 3: The redundant part in the gastric tube apex is removed. Results We analyzed 199 consecutive patients who underwent this anastomosis in our institute from 2004 to 2019. There was no postoperative mortality. Anastomotic leak (Clavien-Dindo classification; Grade ≥ II) rate was 2.5%. Anastomotic stricture which required balloon dilation was 3.5%. Conclusion The anastomotic complication rates in the hand-sewn anastomosis were comparable to those of the mechanical stapled anastomosis in the previous reports. Video https://www.dropbox.com/s/sxnxs4962aj5n5k/anastomosis.mp4?dl=0.

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Comparison Between Minimally Invasive and Open Gastrectomy for Gastric Cancer in Europe: A Systematic Review and Meta-analysis

Scandinavian Journal of Surgery ◽

10.1177/1457496916630654 ◽

2016 ◽

Vol 106 (1) ◽

pp. 3-20 ◽

Cited By ~ 16

Author(s):

I. D. Kostakis ◽

A. Alexandrou ◽

E. Armeni ◽

C. Damaskos ◽

G. Kouraklis ◽

...

Keyword(s):

Gastric Cancer ◽

Blood Loss ◽

Minimally Invasive ◽

Hospital Stay ◽

Postoperative Bleeding ◽

Postoperative Mortality ◽

Duodenal Stump ◽

Conversion Rates ◽

Pubmed Database ◽

Duodenal Stump Leakage

Aims: We compared laparoscopic and robotic gastrectomies with open gastrectomies and with each other that were held for gastric cancer in Europe. Methods: We searched for studies conducted in Europe and published up to 20 February 2015 in the PubMed database that compared laparoscopic or robotic with open gastrectomies for gastric cancer and with each other. Results: We found 18 original studies (laparoscopic vs open: 13; robotic vs open: 3; laparoscopic vs robotic: 2). Of these, 17 were non-randomized trials and only 1 was a randomized controlled trial. Only four studies had more than 50 patients in each arm. No significant differences were detected between minimally invasive and open approaches regarding the number of retrieved lymph nodes, anastomotic leakage, duodenal stump leakage, anastomotic stenosis, postoperative bleeding, reoperation rates, and intraoperative/postoperative mortality. Nevertheless, laparoscopic procedures provided higher overall morbidity rates when compared with open ones, but robotic approaches did not differ from open ones. On the contrary, blood loss was less and hospital stay was shorter in minimally invasive than in open approaches. However, the results were controversial concerning the duration of operations when comparing minimally invasive with open gastrectomies. Additionally, laparoscopic and robotic procedures provided equivalent results regarding resection margins, duodenal stump leakage, postoperative bleeding, intraoperative/postoperative mortality, and length of hospital stay. On the contrary, robotic operations had less blood loss, but lasted longer than laparoscopic ones. Finally, there were relatively low conversion rates in laparoscopic (0%–6.7%) and robotic gastrectomies (0%–5.6%) in most studies. Conclusion: Laparoscopic and robotic gastrectomies may be considered alternative approaches to open gastrectomies for treating gastric cancer. Minimally invasive operations are characterized by less blood loss and shorter hospital stay than open ones. In addition, robotic procedures have less blood loss, but last longer than laparoscopic ones.

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Surgical treatment of duodenal ulcers, Devine (Surg., gyn. a. obst.. 1925 № 1)

Kazan medical journal ◽

10.17816/kazmj78638 ◽

2021 ◽

Vol 22 (8) ◽

pp. 967-967

Author(s):

M. Chalusov

Keyword(s):

Surgical Treatment ◽

Posterior Wall ◽

Duodenal Ulcers

Devine (Surg., Gyn. A. Obst .. 1925 № 1) notes the difficulty of surgical treatment of old, callous ulcers on the posterior wall of the duodenum: resection of these ulcers is always difficult and dangerous, gastroenterostomy is often accompanied by their recurrence.

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