Tishakova Viktoriya Eduardovna (surgeon of the surgical department of Surgery Center of Branch No.1 of the Main Military Clinical Hospital named after Academician N.N. Burdenko; applicant of A.V. Vishnevsky National Medical Research Center (Moscow))
Ruchkin Dmitry Valerievich (M.D., A.V. Vishnevsky National Medical Research Center (Moscow))
Gritskevich Alexander Anatolyevich (MD, Professor Vishnevsky National Medical Research Center for Surgery of the Ministry of Health of Russia (Moscow); Peoples' Friendship University of Russia (Moscow))
Efimenko Nikolay Alekseevich (Corresponding Member of the Russian Academy of Sciences, Consultant Surgeon of Surgery Center of Branch No.1 of the Main Military Clinical Hospital named after Academician N.N. Burdenko (Moscow))
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The article reflects the results of a study aimed at evaluating the effectiveness and prove the feasibility of using isoperistaltic jejunogastroplasty (modification of the Merendino-Dillard operation) as a method of primary reconstruction after subtotal proximal gastrectomy.
The analysis of the results of treatment of 97 patients operated on for surgical diseases of the cardiac stomach in the period from 2011 to 2019 was carried out. 92.8% of them had malignant neoplasms of the esophagogastric junction. Proximal gastric resection (PRG) was performed using isoperistaltic jejunogastroplasty (modified by Merendino-Dillard) (50 patients - Group I or main) and standard PRG with direct esophagogastroanastomosis (47 patients - Group II or control group).
The closest results in the main group compared with the control group did not have significant differences: blood loss was 410±16 and 360±13 ml; the duration of stay (bed-days) in the ICU - 0.9 days. and 2.2 days, in the hospital - 10.1 days. and 13.4 days. respectively. Complications developed in 25 patients (25.8%): in group I there were 13 (26.0%), in group II - 12 (25.5%), while the frequency of complications associated with surgery (surgical) was 8 (16.0%) and 7 cases (14.9%), respectively (p> 0.05). Postoperative complications of the long-term period (after 12 months) associated with the reconstruction of the gastrointestinal tract were noted in 18 (20.9%) patients: with a direct esophageal-gastric anastomosis - in 13 (31.0%) versus 5 (11.3%) during reconstruction of the gastrointestinal tract with jejunogastroplasty modified by Merendino-Dillard, while the frequency of reflux esophagitis was observed in group I - in 2 (4.5%) and in group II - in 6 (14.3%) cases (p <0,05). The indicator of good health in the main group was 72.7%, in the control - 47.8% (p <0.01).
The safety and physiological effectiveness of isoperistaltic jejunogastroplasty (a modification of the Merendino-Dillard operation) make it the method of choice after subtotal proximal gastrectomy.
Keywords:stoma cancer, proximal resection of the stomach, reconstruction with proximal resection of the stomach.
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Citation link:
Tishakova V. E., Ruchkin D. V., Gritskevich A. A., Efimenko N. A. Results of the proximal gastric resection depending on methods of gastrointestinal tract reconstruction // Современная наука: актуальные проблемы теории и практики. Серия: Естественные и Технические Науки. -2021. -№11. -С. 198-204 DOI 10.37882/2223-2966.2021.11.34 |
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