RU2186534C2 - Semiclosed method for applying choledochoduodenoanastomosis - Google Patents

Abstract

FIELD: medicine, surgery. SUBSTANCE: formation of anastomosis of common bile duct and duodenum is conducted by semiclosed method due to applying the first half of anastomosis not opening the duodenal lumen. The method enables to simplify the technique and increase the reliability of choledochoduodenoanastomosis. EFFECT: higher efficiency.

Description

 The invention relates to medicine, namely to surgery, and can be used in the treatment of biliary tract disease.

 Currently, the most common method of applying choledochoduodenoanastomosis (CDA) according to the method of Yuras-Vinogradov [1]. Its disadvantage is that the application of the first sutures in the area of the internal angle of the anastomosis is difficult due to the deep location of the lower angle of the cut of the duodenum and choledoch, poor visibility of the anastomosis zone, mainly due to the prolapse of the duodenal mucosa into the area of the future anastomosis and blood leakage from a bowel incision [2].

 The purpose of the invention is to facilitate the application technique and increase the reliability of choledochoduodenoanastomosis.

 The method consists in the following: after isolating a portion of the common bile duct in its supra- or retro-duodenal part by 2-2.5 cm, a longitudinal section of its anterior wall 2 cm long is made through all layers between two pre-applied suture-holders. After opening the lumen of the common bile duct, its contents are evacuated by suction. Then, in the transverse direction at the site of the proposed anastomosis on the duodenum, its wall is dissected to the submucosal layer. The vessels of the submucosal layer that swell at the same time are stitched under the control of the eye. Anastomosis is formed by a single-row atraumatic absorbable suture material (preferably 4-0 vicryl). The first suture is superimposed on the lower corner of the bile duct, and the bile duct wall is pierced through, and the wall of the duodenum is stitched with a serous-muscular-submucosal suture. The needle is injected externally into the common bile duct and from the inside out through the wall of the duodenum with a serous-muscular-submucosal suture. Sutures are applied alternately one by one on each side of the anastomosis 2-3 mm apart. The spacing of the puncture from the edge of the cut is 2 mm. After the formation of half the perimeter of the anastomosis, the lumen of the duodenum is opened, the contents are aspirated, with significant bleeding from the intestinal wall, the vessels are ligated. Further application of the anastomosis continues in an open way.

 The proposed method for applying choledochoduodenoanastomosis is more convenient than the classical technique, since when applying the technically more complex first half of the anastomosis, the mucous membrane of the duodenum does not prolapse into the anastomosis, blood and intestinal contents do not flow, which improves the visibility conditions in the CDA application area.

 Example.

Patient M., 71 years old, medical history 3767. Was admitted to the clinic 04/30/99. with obstructive jaundice, which appeared 1 month before admission after an attack of pain in the right hypochondrium. Over the course of a month, jaundice increased, the last 5 days in the evenings were chills, body temperature rose to 38.5 ^o C. Examined: ultrasound - gall bladder 78 • 35 mm, contains calculi of various diameters, bile duct - 20 mm, in its lumen calculus with a diameter up to 16 mm; pancreatic head 30 mm. With a diagnosis of gallstone disease, cholecystocholedocholithiasis, cholangitis, obstructive jaundice - the patient was operated on. A laparotomy was made with a paramedian incision on the right. During revision of the abdominal organs: the gall bladder is of normal size, lumens are determined by calculi of various diameters, the common bile duct is expanded to 2.5 cm, palpation in the supra- and retroduodenal parts are determined by two calculi the size of a hazelnut. Cholecystectomy was performed from the neck with separate ligation of the cystic artery and cystic duct, the gallbladder bed was sutured with an upholstered suture, cholangiography through the stump of the cystic duct - the common bile duct was enlarged, in its lumen there were two major filling defects, suspected of calculi, the terminal part of the choledoch was narrowed to 2 mm 1.5-2 cm, contrast in the duodenum arrives. After the preparation of the retroduodenal part of the choledochus and the preliminary application of two suture-holders, a choledochotomy was made 2.5 cm long, turbid bile with an unpleasant odor was released from the choledoch, two large calculi 1.8 • l, 5 • 1 cm and 1.5 • 1 • were removed 1 cm. The bile duct is washed with a 0.5% dioxidine solution, a probe with a diameter of 3 mm does not pass into the duodenum. The choledochoduodenostomy is superimposed in a semi-closed manner. In the subhepatic space to the bed of the gallbladder summed up the glove-tube drainage through contraception in the right hypochondrium. The abdominal cavity is drained. The wound of the abdominal wall is sutured in layers. In the postoperative period, conservative therapy was performed. There were no complications. Sutures were removed on the 10th day. Jaundice is stopped. The patient was discharged in satisfactory condition.

Sources of information:
1. Vinogradov V.V. // Surgery. - 1960. - 9. - P.145.

 2. Ryneyskiy S.V., Morozov Yu.I. Choledochoduodenostomy. - M.: Medicine, 1968, 176 p.

Claims (1)

 The method of applying choledochoduodenostomy, characterized in that the formation of the anastomosis of the common bile duct and duodenum is done in a semi-closed manner, while the first half of the anastomosis is performed without opening the lumen of the duodenum.