METHOD FOR PERFORMING LAPAROSCOPIC SUBTOTAL DISTAL RESECTION OF THE STOMACH

摘要

FIELD: medicine. ;SUBSTANCE: invention relates to medicine, namely abdominal surgery, oncology. Five trocars are installed: 12-mm port in the navel area; 5-mm port in the left mesogastrium along the midclavicular line at the navel level; 15-mm port in the left hypochondrium 2 cm below the costal arch along the midclavicular line; 5-mm port in the right mesogastrium along the midclavicular line at the navel level; 5-mm laparoscopic port in the right mesogastrium along the antero-axillary line 3 cm below the costal arch. The distal part of the stomach is crossed at the level of the upper horizontal branch of the duodenum and the proximal part at the level of the spleen gate, while placing the stitching device at an angle of 90° to the large curvature of the stomach. Gastroenteroanastomy is formed on the back wall of the stomach. The trocar in the left hypochondrium is removed and the hole is expanded to 40 mm. Through the resulting mini-approach, the previously cut-off drug is extracted and the leading and withdrawing loops of the small intestine leading to gastroenteroanastomy are removed to the anterior abdominal wall and extracorporeal, inter-intestinal single-row anastomosis is applied. A trapping drainage is installed in the right mesogastrium under the liver. On the 3rd -5th days, gastroenteroanastomy is contrasted and, with the consistency of the anastomosis and the absence of contrast agent congestion, the trapping drainage is removed. The patient is discharged from the hospital on the 9th -13th days, while the criteria for a favorable outcome of treatment are the healing of postoperative wounds on the 7th -8th days, the level of blood leukocytes not exceeding 8.6x109 units per liter. ;EFFECT: method makes it possible to simplify the stage of crossing the stomach stump, reduce the length of the stapler suture due to the location of the stitching device at an angle of 90° to the large curvature of the stomach and reduce the likelihood of postoperative ventral hernia. ;1cl, 3 dwg, 2 ex