ASPECTS OF DIAGNOSIS AND RECONSTRUCTIVE-RESTORATIVE SURGERY IN FUNCTIONAL DISORDERS OF DIGESTIVE SYSTEM

Abstract

Aim. The aim of the study was to improve the outcomes and functional results of gastric and duodenal surgeries and as well as those of associated organs at the expense of perfection of diagnosis, surgical correction and prevention of motor-evacuatory and secretory disorders. Materials and methods. For diagnosis, the following special as well as original methods of study were used: intragastric pH-metry, balloonometric method, radiotelemetric and tensometric methods for assessment of gastric motor activity and intestinal motility; radioisotopic methods for estimation of functional status of hepatobiliary and gastrointestinal systems; roentgenological methods of double contrast study of the stomach and duodenum, endoscopic methods, pathomorphological studies, statistical processing of results with “Biostatic” program. Results. One thousand two hundred and forty eight (1248) patients underwent selective proximal vagotomy; 2199 patients - gastric resection with formation of artificial pyloric canal in different volumes (from antrumectomy to subtotal); 190 patients - gastrectomy with formation of oesophageal-intestinal reservoir, 403 patients - reconstructive-restorative surgeries for postoperative functional disorders. Conclusions. In most patients it is possible to reach good operative results and prevent development of postoperative complications at the expense of purposeful diagnosis of initial disorders, differentiated choice of surgical technique depending on the degree of severity of the diagnosed pathology and observation of certain techniques, providing optimal conditions for restoration and preservation of the most important functions of digestive system.

Keywords

Motor-evacuatory disorders / reconstructive-restorative surgery / selective proximal vagotomy / gastric resection / gastrectomy

References

[1] Багненко С.Ф. Назаров В.Е., Кабанов М.Ю. Методы фармакологической коррекции двигательно-эвакуаторных нарушений желудка и двенадцатиперстной кишки. Русский медицинский журнал 2004; 6 (1): 19-23.

[2] Жерлов Г.К., Кошель А.П., Клоков С.С. Реконструктивные операции на желудке в лечении постгастрорезекционных расстройств. Вопросы реконструктивной и пластической хирургии 2002; 3: 24-27.

[3] Жерлов Г.К., Кошель А.П. Функциональные результаты операций формирования «искусственного желудка» после гастрэктомии и субтотальной дистальной резекции желудка. Вестник хирургии 1996; 106 (1): 26-29.

[4] Кузин М.И. Актуальные вопросы хирургии язвенной болезни желудка и двенадцатиперстной кишки. Хирургия 2001; 1: 27-32.

[5] Лоранская И.Д., Вишневская В.В. Изучение моторной функции желчевыделительной системы и гастродуоденальной зоны при патологии билиарного тракта. Русский медицинский журнал 2005; 7 (1): 1-7.

[6] Майстренко Н.А., Мовчан К.Н. Хирургическое лечение язвы двенадцатиперстной кишки. СПб.: Гиппократ 2000; 360.

[7] Оноприев В.И. Этюды функциональной хирургии язвенной болезни. Краснодар 1995; 296.

[8] Репин В.Н., Гудков О.С., Репин М.В. Гастрэктомия с созданием тонкокишечного резервуара. Хирургия 2000; 1: 35-36.

[9] Черноусов А.Ф., Богопольский П.М., Аба М. Диагностика и лечение синдрома приводящей петли. Хирургия 1995; 1: 41-45.

[10] Fein M., Fuchs K.H., Stopper H., Diem S., Herderich M. Duodenogastric reflux and foregut carcinogenesis: analysis of duodenal juice in a rodent model of cancer. Carcinogenesis 2000; 21 (11): 2079-2084.

[11] Hosouchi Y., Hara T. Evaluation of transverse colon interposition following total gastrectomy in patients with gastric carcinoma. Oncol. Rep. 1998; 5 (1): 87-98.

[12] Ikeda M., Ueda T., Shiba T. Reconstruction after total gastrectomy by the interposition double jejunal pouch using double stapling technique. Brit. J. Surg. 1998; 85 (3): 398-402.

[13] Lorusso D., Linsalata M., Pezzolla F., Berloco P., Osella A.R., Guerra V., Di Leo A., Demma I. Duodenogastric reflux and gastric mucosal polyamines in the non-operated stomach and in the gastric remnant after Billroth II gastric resection. A role in gastric carcinogenesis? Anticancer Res. 2000; 20 (3В): 2197-2201.

[14] Nozoe T., Anai H., Sugimachi K. Usefulness of reconstruction with jejunal pouch in total gastrectomy for gastric cancer in early improvement of nutritional condition. Am. J. Surg. 2001; 181 (3): 274-278.

RIGHTS & PERMISSIONS

Repin V.N., Repin M.V., Gudkov O.S., Efimushkina A.S., Artmeladze M.S., Polyakov S.N.