METHOD FOR SEPARATION OF CHOLECYSTODUODENAL FISTULA WITH SUBSEQUENT CHOLECYSTECTOMY IN PATIENTS WITH OBESITY FROM MINI-ACCESS

摘要

FIELD: medicine; abdominal surgery.;SUBSTANCE: after dissection of an anterior abdominal wall with mini-access, a wound expander is installed. A section is isolated in a bottom area of gallbladder with a size of 1.5×1.5 cm, gallbladder is dissected in the bottom area, and content is evacuated. After that, a gallbladder cavity is inspected with a probe and a fistula hole is detected. Then, cholecystoduodenal fistula is separated by leaving on duodenum a part of the gallbladder wall tightly soldered to duodenum, and a part of the gallbladder wall soldered to liver is left on liver. Gallbladder walls are partially removed, then cystic artery and cystic duct are ligated under visual control. ;EFFECT: method allows one to separate duodenum from gallbladder without its deserization and damage, prevent damage to large vessels and the development of bleeding, exclude damage to extrahepatic bile ducts and the liver tissue itself, without increasing intra-abdominal pressure in patients with obesity.;1 cl, 9 dwg, 1 ex