METHOD FOR FORMING ANTI-REFLUX CHOLEDOCHO-JEJUNO-ANASTOMOSIS IN GASTRECTOMY

摘要

FIELD: medicine.SUBSTANCE: invention relates to surgery and can be used to form anti-reflux choledocho-jejuno-anastomosis in gastrectomy with pancreatoduodenal resection. Jejunal reservoir acting as the stomach, oesophagojejunoanastomosis, choledocho-jejuno-anastomosis, pancreatico-jejuno-anastomosis are formed. In order to form the jejunal reservoir acting as the stomach, a two-layer Brown's enteroenteroanastomosis extended up to 15 cm is applied, for this purpose, jejunum edges are brought together and dissected, anterior and posterioranastomosis lips are stitched, the formed reservoir is fixed with nodal sutures to the edge of the opening of the transverse colon mesentery. To apply the choledocho-jejuno-anastomosis, sutures are made with a choledochous duct wall and a jejunal reservoir wall, by dissecting and isolating a serous-muscular layer with the dissection of a mucosal-submucosal layer, residual limb of the choledochous duct and mucosal-submucosal layer of the jejunum are brought together and centered, a first row of sutures is applied, seizing the mucosal-submucosal layer and the choledochous duct wall, without piercing through the latter, intestine lumen is further opened in the form of a "proboscis", the choledochous duct is lowered into its lumen, a second row of sutures is further formed over the first one, retreating 1 cm from the residual limb of the choledochous duct.EFFECT: method allows creating a reliable anti-reflux mechanism.1 cl, 3 dwg, 1 ex