METHOD OF SURGERY OF CHRONIC ULCER IN POSTERIOR DUODENAL WALL, COMPLICATED BY BLEEDING

摘要

FIELD: medicine; surgery.;SUBSTANCE: longitudinal piloroduodenotomy is performed. The local hemostasis is performed, followed by vagotomy and gastric drainage. After hemostasis, the mucous of posterior duodenal wall is dissected by two incisions along the ulcer margins till the submucous in transversal direction to intestine length. The incision is continued from the posterior wall by inferior and superior duodenal walls with transition to the anterior wall, till the edge of piloroduodenotomy. The created rectangle mucous flap is removed. The mucous-submucous sheaths of duodenum and pylorus are dissected distally and proximally off ulcer, for 0.5-1 cm along all walls. The loose ends of the mucous-submucous sheaths of pyloric area of stomach and duodenum are sutured by continuos screwing in stitches. In this way, the lumens of stomach and duodenum are isolated from each other. Demucoused piloroduodenotomic edges are pulled in turn and sutured into the ulcer crater, covering one margin by another as coat flaps. In addition, the unsutured adjacent margins of piloroduodenotomic incision are sutured by knotted stitches. After duodenum mobilisation by a Kocher maneuver, the gastroduodenal anastomosis by Jabouley is formed. The anterior external row of mucous-muscle stitches is continued upwards and covers the area of sutured ulcer.;EFFECT: method reduces surgery trauma, provides reliable hemostasis by biologic tamping of ulcer, and prevention of bleeding relapse in remote time period by avoiding gastroduodenal passage along superior part of duodenum.;5 dwg, 2 ex