New technologies for stomach resection surgery in atypical conditions

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OBJECTIVE

To develop original technologies that simplify and increase an effectiveness of stomach resection in case of «difficult» duodenal ulcers.

MATERIAL AND METHODS

Healing of gastroduodenostomy was experimentally observed under tension of anastomosed segments. In the first group (12), gastric resection was performed in a volume of 2/3 without tension of the anastomosed sections using a two-row suture. In the second group (12), stomach resection was accompanied by modeling of tension of the anastomosed sections under a pressure equal to 2.5—3.6 N (245—350 g). In the third group (12), gastric resection was performed in the same fashion as in the second group, but gastroduodenostomy was sutured using a single-row everted seams and hypotraction serous-muscular sutures. The results of Billroth-I gastrectomy using traditional (n=86) (classic double-row Lambert-Albert suture) and developed technologies (n=112) were analyzed in patients with complicated gastric and duodenal ulcers.

RESULTS

The obvious advantages of the developed technologies have been experimentally proved for gastric resection under tension of anastomosed sections. There was no inconsistency of gastroduodenostomy, whereas traditional two-row suture was followed by this complication in 58,3% of cases. A favorable course was based on the relatively low inhibition of tissue blood supply in regenerating structures that was manifested by significantly less redox potential. Reduced lipid peroxidation and phospholipase activity in tissue structures along the suture line was also recorded. We obtained the positive clinical results of this approach in patients with complicated course of duodenal ulcer. Billroth-I gastrectomy was performed in all patients. Gastroduodenostomy failure was absent. Overall postoperative morbidity was 6,3%. In case of double-row anastomosis, suture failure occurred in 9,3% of cases, incidence of complications — 57,0%. This procedure was performed for gastric ulcer as a rule.

CONCLUSION

The developed technologies greatly simplify resection of stomach and duodenum in the most difficult atypical conditions and ensure physiological Billroth-I surgery. The obvious benefit of this technology is simplified resection per se that makes it accessible to novice surgeons.

Keywords:

gastric resection

everted suture

hypotraction sutures

regeneration

postoperative complications

Authors:

Vlasov A.P.

Ogarev Mordovia State University

ORCID: 0000-0003-4731-2952

Received:

18.04.2020

Accepted:

28.04.2020

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