RECONSTRUCTIVE ONE- AND TWO STEP JEJUNOGASTROPLASTY AFTER TOTAL GASTRECTOMY IN BLEEDING GASTRIC CANCER
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Keywords

bleeding gastric cancer, reconstructive operation, gastrectomy, jejunogastroplasty

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Shepetko, E., Fomin, P., Garmash, D., Belskiy, A., Kozak, Y., & Koshman, I. (2017). RECONSTRUCTIVE ONE- AND TWO STEP JEJUNOGASTROPLASTY AFTER TOTAL GASTRECTOMY IN BLEEDING GASTRIC CANCER. Medical Science of Ukraine (MSU), 13(1-2), 55-65. https://doi.org/10.32345/2664-4738.1-2.2017.08

Abstract

Relevance. Modern and topical questions of surgical treatment of acute bleeding gastric cancer are considered with the use of innovative hardware technologies of operative interventions with the formation of an artificial ventricle (jejunogastroplasty) after total gastrectomy (GE).

Objective. Development and introduction of new technologies and methods of one-stage and two-stage reconstructive jejunogastroplasty (JGP), which can improve the functional results of total gastrectomy for acute bleeding gastric cancer.

Materials and methods. Are analyzed 30 patients after the GE in conjunction with jejunogastroplasty (JGP) for bleeding gastric cancer. Men were 22 (73 %), women – 8 (27 %). In 68 % of patients who underwent JGP verified III st. and IV st. neoplastic process. When forming an artificial stomach (reconstructive JGP) used a variety of options and technologies: JGP manually performed in 3 (10 %), hardware – in 27 (90 %).

Results. JGP by Roux loop applied in 6 (20 %), Ω-loop JGP with Brownian anastomosis – in 16 (53 %), and in 8 (27 %) performed reconstructive hardware JGP in a functionally advantageous embodiment including of the duodenum. In 28 patients lymph node dissection performed in the amount of D2, two – D1 using an ultrasonic scalpel and the machine welding of biological tissues. Deaths were not. Developed and implemented the concept two-step JGP after total GE at bleeding  gastric cancer. In the first phase, the GE with lymph node dissection. In developing dumping syndrome, nongastric fatigue, weight loss, violation digestiv tract function in the postoperative period and in the absence of data on the progression of the tumor process in the second phase after 4-6 months (sometimes 1-1,5 years) after total GE undertaken reconstructive JGP with the creation of artificial jejunum  reservoir. Developed sixteen variants hardware reconstructive JGP without including and with the including of the duodenum  in the digestive transit. The best functional results obtained after reconstructive JGP  including of the duodenum.

Conclusions. In patients young and middle age after total GE at bleeding gastric cancer  it is advisable to complement perfoming JGP  including of the duodenum. The use of one- and  two step JGP after total GE improves the quality of life of the patients in the late postoperative period.

https://doi.org/10.32345/2664-4738.1-2.2017.08
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