Technique of resection of the stomach in peptic ulcer. Resection of the stomach: is such an operation performed for weight loss and how effective is it? Subtotal distal gastric resection billroth 2

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Technique of resections of the stomach. The upper median incision opens the abdominal cavity and examines the stomach and duodenum. Sometimes, to detect an ulcer, the omental sac is opened, dissecting the gastrocolic ligament (GCL), and even a gastrostomy is performed, followed by suturing of the gastric wound. The volume of the resected part of the stomach is determined, after which the stomach and transverse OK are brought into the wound. The avascular area with stretched ACL is dissected. YOS is taken in parts on clamps and crossed. In the corner between the head of the pancreas and the duodenum, the gastroepiploic artery is found and, together with the LSG, it is crossed between two clamps and tied up.

Under the control of a finger passed through the lesser omentum, they are grasped with clamps, crossed and tied off the right gastric artery. The lesser omentum is dissected to the cardial part of the stomach. It should be noted that often there are vessels from the left gastric artery to the liver. Consider it necessary to check whether there is a hepatic artery among them. Ligation of the main trunk of the hepatic artery, abnormally extending from the left gastric artery (LVA), threatens with liver necrosis. Above the place of division of the LV, an incision is made in the serous membrane at the lesser curvature of the stomach. A clamp is made into the incision along the wall of the stomach towards the finger drawn to the posterior surface of the stomach at the lesser curvature.

Clamps are applied to the LV separated from the stomach, crossed and bandaged. The boundaries of gastric resection are finally determined and, if necessary, their expansion is additionally mobilized for greater curvature. The duodenum is grasped with a clamp closer to the pylorus, the second clamp is applied to the stomach at the pylorus. Between the clamps, the stomach is cut along the duodenum. In cases where the ulcer is located in the duodenum, the latter is crossed below the ulcer, if mobilization of the intestine allows, since on its posteromedial wall, at a distance of 2-8 cm from the pylorus, there is a BDS. The further course of the operation depends on the method of restoring the patency of the gastrointestinal tract. In accordance with this, several types of gastric resection are distinguished: according to Billroth-I, according to Billroth-II, gastrojejunoplasty.

Methods of surgical treatment of gastric ulcer (according to A.A. Shalimov. V.F. Saenko):
1 - resection of the stomach according to Billroth-1; 2 - resection of the stomach according to Billroth-II; 3 - resection of the cardial part of the stomach; 4 - ladder resection of the stomach (by Schoemaker, Schmieden, Pauchet); 5 - resection of the stomach according to Kelling-Madlener; 6 - resection of the stomach with a small intestine insert according to Zakharov; 7 - Nissan operation; 8 - vagotomy with pyloroplasty (according to Farris, Smith); 9 - resection of the stomach with preservation of the pylorus (according to A.A. Shalimov); 10 - vagotomy, wedge resection of the ulcer, pyloroplasty (according to Zollinger); 11 - Nissan operation; 12 - selective vagotomy, antrumectomy with preservation of the pylorus (according to A.A. Shalimov); 13 - resection of the cardial part of the stomach, selective vagotomy, gastroduodenostomy (according to A.A. Shalimov); 14 - selective proximal vagotomy, wedge resection of the ulcer, pyloroplasty (according to Holle)

Mobilization of the stomach for ulcers:
a-c — ligation of the right gastroepiploic artery and vessels of the posterior surface of the duodenum; d — LV ligation

When using UKL-60, the tantalum suture is peritonized with gray-serous sutures, except for the area near the greater curvature, which, after excision of the suture with tantalum staples, is anastomosed with the duodenum. The unsewn part of the stump of the stomach and duodenum is brought together. Departing 0.5 cm from the edge of the incision, nodal gray-serous sutures are applied to the posterior lips. The posterior lip of the anastomosis is sutured with a continuous catgut overlapping suture, and the anterior lip with a dip Connell suture. Gray-serous sutures are applied to the anterior lip of the anastomosis, reinforcing the corners with U-shaped gray-serous sutures. The greater omentum, and in its absence, the mesentery of the transverse OK is sutured to the stomach and duodenum in the area of ​​​​the entrance to the stuffing bag, eliminating the entrance to the latter.

Dimensions of the removed part of the stomach:
1 - subtotal resection; 2 - resection of 2/3 of the stomach; 3 - antrumectomy

With highly located ulcers of the lesser curvature of the stomach, the latter is lengthened (Shosmaker, 1957; P.M. Shorluyan, 1962). When a large part of the stomach is removed and there is no area of ​​great curvature convenient for creating a tube, HEA is applied, i.e. the operation is completed according to Billroth-II.

Modifications of stomach resection according to Billroth-I (according to A.A. Shalimov, V.F. Saenko):
1 Pean, Billroth; 2—Rydygler, Billroth; 3 - Kocher; 4 - Schoemaker, Schmieden, Pauchet; 5, 6 - Haberer; 7 - Goepel, Babcocr; 8 - Finsterer; 9 - Kutscha-Usserg, Pototschnig; 10 - Ito Soyesima; 11 - Horsley; 12 - Leriche; 13 - Lundblad; 14 - Winkelbauer; 15 - Oliani; 16 - Kirschner; 17 - Mirizzi; 18 - Rechtenmacher; 19 - A. I. Lubbock; 20 - Shoemaker; 21 - Corriego and Bayer, 22 - Vician; 23 - Clemens; 24 - A.A. Shalimov; 25 - Tomoda; 26 - G.P. Zaitsev; 27 - A.A. Shalimov; 28 - Andreoiu; 29.30 - AA Shalimov; 31.32 - G.A. Khai; 33 - Orr; 34.35 - G.S. Topprover; 36 - Zacho, Amdrup

If it is impossible to complete the operation by applying a direct GDA, an end-to-side anastomosis is applied. The terminolateral GDA according to Gaberer-Finney-Finsterer has received the greatest distribution. In this case, the stomach stump is sutured from the side of the lesser curvature, leaving a section along the greater curvature for anastomosis with a vertically dissected anterior wall of the duodenum (Andreotu, 1961; Tomoda, 1961; and others).

Considering the advantages of the Billroth-I method as the most physiological, preventing or significantly reducing the severity of the dumping syndrome, A.A. Shalimov (1962) developed a technique for resection of the stomach, in which, in the case of leaving at least a small part of the fundus of the stomach, the stomach stump is connected without tension of the sutures with the duodenum.

Resection of the stomach according to Billroth-II is by far the most technically developed operation. This explains its availability and prevalence. Various modifications of the Billroth-II method are classified as follows (A.L. Shalimov, V.F. Saenko, 1987).

I. GEA by side-to-side type:
1) anterior anterior colonic anastomosis (Bilroth, 1985); Y-anastomosis (Schiassi, 1913);
2) anterior anterior colonic anastomosis with EEA (Braun, 1987);
3) anterior retrocolic anastomosis (Dubourg, 1998);
4) posterior anterior colonic anastomosis (Eiselberg, 1899);
5) posterior retrocolic anastomosis (Braun, 1894; Hacker, 1894).

II. Side-to-end HEA - posterior retrocolic U-anastomosis (Roux, 1893).

III. Gea by type end in horses:
1) retrocolic U-anastomosis (Moskowicr, 1908);
2) anterior-colic Y-anastomosis (Rydygier, 1904; Eoresi, 1921).

IV. GEA end-to-side:
1) anterior colonic total U-anastomosis (Klonlein, 1897);
2) anterior colonic total anastomosis with a Brown fistula (Balfour, 1927);
3) anterior colonic total antiperistaltic anastomosis (Moynihan-II, 1923);
4) anterior-colon inferior anastomosis (Hacker, 1885; Eiselsberg, 1988), Y-anastomosis (Cuneo, 1909);
5) anterior colonic total anastomosis (Reichel, 1908; Rolya, 1911);
6) Y-anastomosis (Moynihon-I, 1919);
7) retrocolic upper anastomosis (Mayo, 1919);
8) retrocolic middle anastomosis (Wilms, 1911; Waes, 1947);
9) retrocolic inferior anastomosis (Hofmeister, 1911; Finsterer, 1914);
10) retrocolic lower horizontal anastomosis (Neuber, 1927);
11) retrocolic lower U-anastomosis (A.A. Opokin, 1938; IL. Ageenko, 1953);
12) retrocolic inferior anastomosis with transverse dissection of the TC (M.A. Mazuruk, 1968; Moise and Harvey, 1925).

Resection of the stomach according to Billroth-I. Method A.A. Shalimov:
a - suturing of the lesser curvature; b - the imposition of the first row of sutures between the stump of the stomach and duodenum; c — formation of gastroduodenal anastomosis; d — final view after surgery

Modifications of stomach resection according to Billroth-II (according to A.A. Shalimov, V.F. Saenko):
1 - Billroth; 2- Hacker; 3 - Kronlein; 4 Roux; 5.6 - Braun; 7 - Dubourg; 8 - Elselsberg; 9 - Rydygier; 10 - Moskowicz; 11 - Reichel, Polya; 12 - Cuneo; 13—Wilms; 14 - Hofmeister, Finsterer; 15 -Schiassi; 16 - Mayo; 17-Moynlnan; 18 - Goetze; 19 - Moynihan; 20 - Moise, Harvey; 21 - Balfour; 22 - Neuber; 23 - AL. Opokina, I.A. Ageenko; 24 - Maingot

With unchanged duodenum, the Doyen-Beer, Moynigen-Toprover methods, suturing with the UKL-60 apparatus, the Rusanov method, etc., are most widely used.

With the Doyen-Beer method the stump of the duodenum is stitched in the middle through both walls and tied. A purse-string suture is applied below and the stump is tightened with immersion in it. For the reliability of the seam, the duodenum is sutured to the capsule of the pancreas.

With the Moynigen-Toprover method the duodenum is stitched with a continuous catgut suture, capturing both clamps in the stitch. By pulling the threads (at first alternately) the intestinal stump is hermetically sutured. A purse-string suture is placed at the base of the suture. The catgut threads are tied and the stump is immersed in a purse-string suture, as in the Doyen-Bier method. For tightness, another purse-string serous-muscular suture is sometimes applied.

With the Rusanov method The duodenum is crossed between the clamps applied to the stomach and the remaining part of the intestinal stump, the duodenal stump is sutured with a twisting suture below the sphincter, and the sphincter is removed. The thread is pulled and tied. An 8-shaped purse-string suture is applied, the threads are lifted up, tightened and tied. If the length of the duodenal stump allows, then a second similar 8-shaped suture is applied.

With low-lying penetrating ulcers, the most commonly used methods are Nissen (1933), Znamensky (1947), Sapozhkov (1950), Yudin (1950), Rozanov (1950), Shalimov (1968), Krivosheev (1953).

With the Nissen method The duodenum is transversely crossed at the level of the ulcer penetrating into the pancreas. On the distal edge of the ulcer and the anterior wall of the duodenum, interrupted sutures are applied through all layers. The anterior wall of the duodenal stump is sutured with serous-muscular interrupted sutures to the proximal edge of the penetrating ulcer with the capture of the pancreatic capsule. In this case, the ulcer turns out to be tamponed by the anterior wall of the duodenal stump.

Znamensky's method is a modification of the Nissen method. With this method, the duodenum is transversely crossed over an ulcer penetrating into the pancreas. The anterior wall of the duodenum is sutured with Pribram sutures to the distal edge of the ulcer. The second row of Pribram's interrupted sutures is used to suture the anterior wall of the duodenum to the proximal edge of the penetrating ulcer. Interrupted sutures are applied to the corners of the intestinal stump through all layers of the wall. The stump of the duodenum is peritonized by applying gray-serous interrupted sutures to the capsule of the pancreas and the stump of the duodenum.

When applied "cuff" method (according to Sapozhkov) after mobilization of the stomach, the wall of the duodenum is dissected along the edge of the ulcer penetrating into the pancreas and transversely crossed. in a sharp way the SO of the duodenum is separated from the edge for 2-3 cm. The “cuff” formed from the serous-muscular layers of the intestine is unscrewed, a purse-string suture is applied to the SO, tightened and tied. The edges of the "cuff" are sewn with interrupted sutures. The duodenal stump is sutured with serous-muscular sutures to the edges of the penetrating ulcer to the pancreatic capsule.

Suturing the duodenal stump according to Rusanov

Suturing the duodenal stump according to Znamensky

Sapozhkov's "cuff" method

Yudin's "snail" method

Suturing the duodenal stump according to Rozanov

With the method of A.A. Shalimova after mobilization of the stomach, the wall of the duodenum is released from the crater of the ulcer (when it penetrates into the pancreas) to its lower edge. The intestine is crossed obliquely, refreshing the ulcerative edges and leaving most of the anterior wall. The wall of the duodenum is separated from the distal edge of the ulcerative crater to a depth of 0.5-0.8 cm in an acute way. covered with a serous membrane.

The scar tissue between the intestinal wall and the ulcer is captured in the suture, and the thread is again inserted into the intestinal lumen. From the inside out, the thread is passed through the serous membrane-covered wall at its separated front edge. It turns out a “semi-pouch”, when tightened and tied, the weakest part of the duodenal stump is hermetically sutured, where the edges of the SO, concave into the lumen, come into contact. Sewing up the rest of the duodenal stump, they form a “snail”, which is covered with furrier sutures.

The lateral surfaces of the "cochlea" are sutured with gray-serous sutures, and a semi-purse-string suture is applied to the top of the "cochlea", with which it is sutured to the distal edge of the ulcer crater. To create hermeticism with interrupted U-shaped sutures, the duodenal stump is sutured to the proximal edge of the ulcerative crater and to the pancreatic capsule.

For choledochoduodenal fistulas, exclusion resection is performed in combination with choledochostomy, cholecystoduodenostomy, and choledochoduodenoanastomosis (CDA). In some cases, it is considered possible to cut off the fistula with sewing it into the duodenum or TC.

In some cases, in the presence of a dense infiltrate around the duodenum, if it is impossible to securely suture its stump, then as a last resort it is considered possible (permissible) to use external duodenostomy. A catheter is inserted into the stump of the duodenum, around which the stump is sutured with fixation of the latter. The catheter is covered with an omentum and, together with the drainage, is removed through a separate incision in the right hypochondrium and fixed to the skin. Produce aspiration. On the 8-9th day, the catheter is clamped, and on the 10-12th day it is removed.

Among HEAs, the method developed by Hofmeister (1911) and Finsterer (1914) is the most widely used.

For low-lying unremovable ulcers most often used resection of the stomach to turn off. The technique for processing the duodenal stump was developed by Finsterer (1918), Wilmans (1926), B.V. Kekalo (1961) and other authors. The currently used methods of resection of the stomach to turn off provide for the complete removal of CO from the antral part of the stomach that produces gastrin. There are various ways of resection of the stomach to turn off the ulcer.

Finsterer's method. When the stomach is mobilized, food is maintained in the upper part of the duodenum and the antrum of the stomach 2-3 cm above the pylorus. The stomach is transected 3-4 cm above the last one. The stomach stump is sutured through all layers with continuous catgut suturing or submerged or furrier suture. The second row of sutures is gray-serous nodular.

Wilmans method. The antral part of the stomach at a distance of 4-5 cm from the pylorus is intercepted with a clamp. The seromuscular membrane is dissected below the clamp to CO. A clamp is applied to the SS of the stump and the seroeno-muscular layer of the stump is separated from the SS to the pylorus, where the SS is tied up with a legature and cut off above the latter. Above the stump, the antral serous-muscular tube is sutured tightly with U-shaped sutures.

Kekalo method. It is a modification of the Wilmans technique, differs in the way the seromuscular tube is closed. After removal of CO, the seromuscular cone is dissected along both curvatures and the anterior flap is shortened by half. Above the SO stump, interrupted serous-muscular sutures are applied and covered. The second row of sutures fixes the edge of the anterior flap to the posterior one. Then the posterior flap is folded to the right, covering the second row of sutures, and sutured to the serosa of the anterior flap.

Resection for exclusion according to Kekalo

The mesentery of the transverse OK is dissected in an avascular place, and a loop of the jejunum taken on a holder is passed through the incision. A loop of the jejunum at a distance of 4-10 cm from the duodenal-jejunum bend is sutured to the back wall of the stomach from the lesser curvature towards the greater curvature and downwards for 8 cm with gray-serous interrupted sutures leading to the lesser curvature, diverting to the greater. The bowel loop is sutured in such a way that it is slightly rotated around the long axis. The first suture from the side of the lesser curvature of the stomach passes through the middle of the distance between the free and mesenteric edges of the intestine. Subsequent sutures gradually move to the free edge of the intestine. This suture should coincide with the middle of the anastomosis. Subsequent sutures pass to the opposite side of the intestine.

The last suture is located in the middle of the intestine. At a distance of 0.5-0.8 cm from the applied gray-serous sutures, the stomach is cut off, and if the stomach was resected using the UKL-60 apparatus, the suture with tantalum staples is cut off, and the protruding CO is cut off. Departing 0.5-0.6 cm from the gray-serous sutures, the lateral wall of the jejunum is dissected for 7 cm. A continuous overlapping suture is applied to the posterior lip of the anastomosis through all layers of the common walls.

The anterior lip of the anastomosis is sutured with a catgut thread punctured from the inside to the outside after the last twisting suture of the posterior lip, a continuous dip suture of Connell, or a furrier suture. The initial and final catgut threads of the anastomosis are tied. Interrupted gray-serous sutures are applied to the anterior lip of the anastomosis, and a semi-purse-string suture is placed in the corner of the upper part of the stomach and intestine, capturing the wall of the stomach and intestine from the side of the adductor knee. In this case, the part of the stomach stump, located above the anastomosis, is invaginated inside.

This is the so-called Hofmeister suture. Finsterer (1918) instead of this suture imposed two or three interrupted sutures, capturing the anterior and posterior walls of the stomach and the intestine with two stitches, and thus covered the junction of the anastomosis suture and the lesser curvature. In addition to this, Kapeller (1919) proposed suspension sutures. At the same time, the afferent loop of the jejunum is sutured to the stump with several semi-purse-string gray-serous sutures towards the lesser curvature, creating a spur and reducing the lumen of the afferent colon.

Due to the formation of a spur and the narrowing of the afferent loop, favorable conditions are created for the movement of chyme into the afferent knee. Two or three reinforcing U-shaped sutures are additionally applied at the gastrointestinal angle of the efferent loop. The stomach stump is fixed to the edges of the incision of the mesentery of the transverse OK around the HEA, departing from the last 1-1.5 cm, with gray-serous interrupted sutures at a distance of 2 cm from one another.

Resection of the stomach according to Billroth-II:
a — passage of the TC loop through the window in the mesentery of the transverse colon; b — the beginning of the formation of the posterior lip of the anastomosis; c — final formation of the anastomosis; g - the imposition of suspension sutures on the lesser curvature. Fixation of the stomach stump in the window of the mesentery of the transverse colon

With the Kronlein method in the same way as with the Reichel-Polna method, HEA is applied to the entire lumen of the stomach, but the intestine is passed in front of the transverse OK. To improve the evacuation of the contents of the duodenum, Balfour (1927) supplemented the Kronlein technique with the imposition of a Brownian anastomosis between the afferent and efferent loops.

S.I. Spasokukotsky(1925) proposed fixing the free upper part of the gastric suture with several interrupted sutures to the remnants of the lesser omentum and to the pancreatic capsule. To reduce the throwing of the contents of the stomach stump into the afferent loop, it is sutured at the lesser curvature, and the outlet loop - at the large one.

A. V. Melnikov(1941) in addition to Reichel-Polna resection performed invagination of the lesser curvature, which is partially narrowed by HEA, applied with the entire lumen of the stomach. With this technique, the junction of the four seams becomes more secure. Moynihon (1923) proposed to impose an antiperistaltic anastomosis in front of the colon. In this case, the stomach is crossed perpendicular to the longitudinal axis and its entire lumen is anastomosed.

Roux(1909) proposed to impose a U-shaped anastomosis. The intestinal loop is transected and connected to the stomach, and the proximal part of the intestine is sutured into the side of the efferent colon. Subsequently, it was proposed various options Y-anastomosis, which differ in the way the stomach and intestines are connected.

Neuter(1927) proposed to impose a horizontally located isoperistaltic HEA along the greater curvature. Moise and Harvey (1925) suggested that when anastomosis is applied, the intestine should be transversely cut into half of its circumference.

Resection of the cardial part of the stomach. Usually performed in the presence of an ulcer in it. The main stages of resection: 1) mobilization of the greater curvature of the stomach; 2) mobilization of the lesser curvature of the stomach with ligation of the left gastric artery; 3) mobilization of the duodenum according to Kocher; 4) resection of the proximal half of the stomach; 5) the imposition of the pancreas.

During this operation, the left lobe of the liver is mobilized by dissecting the triangular ligament, and then pushing it to the right. The mobilization of the stomach begins with the intersection of the AJ in the avascular area at the level of the confluence of the right gastroepiploic artery and continues from the bottom up, from the body of the stomach to the esophagus. Clamps are placed on the LOS, and then on the gastro-splenic ligament with short gastric vessels and cross them.

In conclusion, the esophageal-phrenic ligament is dissected, and then the lesser omentum. From the gastro-pancreatic ligament, the left gastric artery and vein are isolated, ligated and crossed. Fedorov's clamps are applied to the esophagus and the proximal half of the stomach is resected. A second row of serous interrupted sutures is applied, leaving the area near the greater curvature unsutured for anastomosis. The stump of the stomach is brought under the esophagus. The pancreas is applied from the side of the greater curvature according to one of the methods that ensure, if possible, the restoration of the closing function of the cardial part of the stomach.

The lost closing function of the cardial part of the stomach is replaced by the creation of a valve mechanism in the pancreas, the use of a small-colonic insert, and plastic transformation of the stomach (G.P. Shorokh et al., 2000).

To prevent reflux, the abdominal part of the esophagus is placed in the submucosal layer of the posterior wall of the stomach stump. The wall of the stomach is sutured over the esophagus.

Intestinal plasty during resection of the stomach. In order to prevent dumping syndrome that occurs after resection of the stomach according to Billroth-II, various options for small and large intestinal plastics have been proposed, which are aimed at including the duodenum in digestion, slowing down the emptying of the stomach stump and increasing the capacity of the latter. Plastic replacement of the removed distal part of the stomach with a segment of the TC was first proposed and developed in the experiment by P.A. Kupriyanov (1924).

In clinical conditions, this operation was first performed by E.I. Zakharov (1938). Its technique is as follows. After mobilization of the stomach, the avascular part of the mesentery of the transverse OK is dissected, the initial loop of the jejunum 20 cm long is inserted into the hole and placed isoperistaltically with respect to the stomach. According to the line planned for resection, the stomach is crossed between the terminals, the part to be removed is turned to the right. The upper half of the lumen of the stomach stump from the side of the lesser curvature is sutured with a two-row suture.

The mesentery of the intestinal loop intended for insertion is dissected towards the root and mobilized so that it is possible to bring the initial part of the graft to the stomach stump without tension. The intestinal loop is cut in the transverse direction. The initial end of the formed graft is sutured, immersed in a purse-string suture and sutured to the upper part of the stomach stump. An end-to-side anastomosis is applied with double-row sutures between the unsewn part of the stomach stump and the gut. Cross the duodenum and remove part of the stomach. Then the outlet loop of the jejunum is crossed and the outlet end of the graft is sutured into the duodenal stump in an end-to-end fashion.

Intestinal patency is restored by stitching the jejunum end-to-end. The sewn loop of the jejunum is moved through the gap into the mesentery of the transverse OK into the free abdominal cavity. The mesentery of the graft on the right and left is sutured with the remnants of the LSG and fixed to the edges of the incision of the mesentery of the transverse OK. There are many options for gastrojejunoplasty after gastrectomy. In all these variants of gastrojejunoplasty, the graft is located isoperistaltically. To slow down the emptying of the gastric stump and create conditions for its portionwise emptying, an antiperistaltic small bowel plasty has been proposed.

Options for primary gastrojejunoplasty after gastric resection (according to A.A. Shalimov, V.F. Saenko):
1 - according to Kupriyanov; 2, 6 - according to Zakharov; 3 - according to Biebl, Henley; 4 - according to Moroney; 5 - Poth; 7, 9 - according to Rozanov; 8 - according to Kurikuca and Urbanovich; 10, 12 - after Poth and Cleveland; 11 - according to Rothkov

Removal of a significant part of the stomach and restoration of the integrity of the esophageal tube is called resection. During surgery, an anastomosis is formed between the duodenum and the gastric stump. Resection of the stomach is prescribed for ulcers and oncology.

general information

This operation is considered quite traumatic and complicated. According to many doctors, the removal of part of the stomach is a necessary therapeutic measure.

Today, the technique of this intervention is well developed. The operation is performed in any department of general surgery. Resection saves even those patients who were considered inoperable.

The type of surgery depends on:

1. Locations of the pathological focus.
2. Damage area.
3. Histological diagnosis.

Relative readings

Surgery is almost always prescribed for:

Also, gastric resection is prescribed when there is no effect in the treatment of chronic ulcers for 30-90 days.

Absolute readings

The operation is always assigned when:

• stomach cancer;
• decompensated pyloric stenosis;
• chronic peptic ulcer stomach.

What are the contraindications

Resection of the stomach is not prescribed for:

The doctor refuses to perform the operation even if the patient is in a very serious condition.

Features of surgery

For the first time this operation was carried out at the end of the 19th century by T. Billroth. He managed to bring to life 2 main methods of gastric resection with subsequent resuscitation of the digestive processes.

Since the beginning of the 2000s, methods of surgical intervention have been known that do not affect the fundamental anatomical functionality of the organ. One of these methods is a longitudinal resection of the stomach.

During the operation, the patient lies face up. Below the corners of the shoulder blades, a roller is placed on it. Most often, the surgeon resorts to distal resection of the stomach. The operation includes the following steps:

1. Mobilization.
2. Clipping.
3. Formation of gastroduodenoanastomosis.
4. Creating an anastomosis between the stump of the stomach and intestines.

The last step in gastric resection is suturing and draining the wound.

Key Interventions

The operation can be:

1. Total.
2. Subtotal.
3. Extensive.
4. economical.

With total surgery, more than 90% of the stomach is removed. With subtotal resection, 4/5 of the volume is cut off. With an extensive operation, 2/3 of the organ is removed. With an economical surgical intervention, from 1/3 to 1/2 of the stomach is cut off.

Today, Billroth 2 resection is being performed. This involves suturing the stump duodenum and stomach. An end-to-side anastomosis is then formed with the small intestine.

Surgery for peptic ulcer

With this pathology, the surgeon resects 2/3-3/4 of the body of the organ. The pyloric and antral sections are removed. This contributes to the relief of relapses.

Today, as an alternative to this method, organ-preserving operations are often used. The surgeon often resorts to excision of the vagotomy that regulates the production of hydrochloric acid. This method is relevant for patients with high acidity.

Surgery for oncology

When diagnosed cancer tumor, the doctor resorts to volumetric resection. During the operation, parts of the lesser and greater omentum are removed. This helps to reduce the risk of relapse.

Cancer cells can be found in lymph nodes adjacent to the stomach. Therefore, in order to avoid metastasis, the doctor removes them too.

If a malignant neoplasm grows into neighboring organs, the surgeon resorts to a combined resection. The stomach is removed with part of some organs of the gastrointestinal tract.

What are the possible complications

In oncology, only part of the organ is often removed. The surgeon connects the stump to the jejunum. This contributes to the emergence of difficulties with the digestion of food. Chemically and mechanically, it is not processed. The result of this is dumping syndrome.

Features of the dumping syndrome

Within half an hour, unpleasant consequences of eating can appear. The duration of discomfort varies from 30 to 120 minutes.

The occurrence of dumping syndrome is due to the penetration of a large amount of unprepared food into the jejunum. The person's heart rate increases. Sweating increases, the patient complains of excruciating dizziness. Sometimes there is a loss of consciousness. Dumping syndrome is not life-threatening, but its quality is significantly reduced.

Other complications

More serious complications include anastomosis. It is an inflammation that develops at the junction of tissues during surgery. Against the background of this complication, edema appears at the resection site. This contributes to the complete obstruction of the gastrointestinal tract.

After about 3-7 days, the inflammatory process stops, the patency is restored. Symptoms of anastomosis disappear. In 8-12% of cases, this pathology becomes chronic. This refers to disability factors.

The main complication of sleeve resection of the stomach is a violation of the functioning of the lower esophageal sphincter. Against this background, the contents of the organ are thrown into the esophagus. This leads to the development of reflux esophagitis. The most specific sign of this complication is excruciating heartburn.

After a longitudinal resection, dyspeptic symptoms appear. Unpleasant symptoms occur after eating and finally disappear after about 4-6 months.

Sometimes there are complications of peptic ulcer disease. There are peptic ulcers. Most often this occurs after surgery according to Billroth-1.

After Billroth-2 surgery, afferent loop syndrome occurs. It is based on violations of the functional and anatomical relations of the digestive tract. An excruciating pain syndrome appears. It is localized with right side hypochondria. The patient often vomits bile, which relieves his condition a little.

Other common complications include:

• recurrence of oncology;
• a sharp decrease in weight;
• development of iron deficiency anemia.

Against the background of insufficient production of the Castle factor in the stomach, B-12 deficiency anemia develops. This condition is less common.

Resection of the stomach affects the digestive system. Therefore, during the postoperative period, the patient undertakes to adhere to the diet prescribed by the doctor. Compliance with all the rules of nutrition contributes to the rapid restoration of all functions of the body.

The diet after surgery involves the exclusion of carbohydrates. The list of prohibited foods primarily includes potatoes and pastries. The diet of the patient should contain a large amount of fat and protein.

With very strong discomfort, it is allowed to take no more than two tablespoons of novocaine solution before meals. Food should be chewed as thoroughly as possible. The postoperative diet is divided into several stages. The first day after surgery, the patient is prescribed therapeutic fasting. Then the food is introduced to him with the help of droppers. In the next step, food is introduced through a probe.

third day

For 3-4 days, the patient is allowed to drink non-acid compotes, fruit drinks. They can be alternated with decoctions and green tea. The patient is allowed to eat mucous soups. On the second it is allowed to serve fish puree. Meat can be eaten, preference should be given to beef, rabbit or turkey.

Low-fat cottage cheese is allowed. You can also eat other easily digestible foods.

Fifth day

On the 5-6th day after resection, you can eat steam omelettes. Vegetables are allowed to bake and grind thoroughly. Porridges cooked on water bring great benefits to the body.

If the food intake is adequately tolerated by the body, the patient's menu can be diversified with foods with a high protein content.

What to eat in a week

7-10 days after gastric resection, the patient is prescribed a sparing diet. Fish and meat products with a high protein content are allowed. It is recommended to give preference to:

1. Non-sour fruits.
2. Groats.
3. Vegetables.
4. Grain.

The amount of light carbohydrates should be limited. It is desirable to reduce the amount of sugar, muffins and confectionery.

What to exclude from the diet

After surgery, the patient must refuse fatty and fried foods. You can not eat canned food, smoked products. It is not recommended to use marinades, pickles. This applies not only to store, but also to home products.

Alcohol intake is prohibited. You should also refrain from sugary carbonated drinks. It is important to exclude the use of refractory fats. First of all, this applies to lamb. It is necessary to abandon products that contain dyes and food additives.

Finally

Adaptation of the body to new conditions takes from six months to 8 months. After this time, the weight gradually returns to normal. To facilitate this period, in addition to diet, the patient should pay attention to physical activity. It is advisable to run more, swim, walk in the fresh air. But overexertion is not recommended.

After that, the person returns to normal life. Disability is usually not assigned. Many people remain functional even without part of the stomach.

Today, modern techniques are used in the course of resection of the stomach. One of the most famous techniques is Billroth. There are two options for such an operation. They have certain differences. Those who are faced with serious diseases of the stomach should know the differences between Billroth-1 and 2. The features of these methods will be discussed further.

General definition

Billroth-1 and 2 techniques are varieties of gastric resection. This is a surgical operation that is used in the treatment of serious diseases. These include pathologies of the stomach, as well as the duodenum. The technique involves the removal of part of the stomach. This restores the integrity of the digestive tract. For this, this connection of tissues is created using a certain technology.

Billroth is a fairly serious operation. It became the first successful surgical intervention of this type. Now the technique is being improved. There are other ways to successfully remove part of the stomach. However, Billroth is still actively used in world-famous clinics. Especially known for the high quality of surgical operations performed according to the presented technique in Israel.

It should be noted that the method of resection largely depends on the location of the pathological process. It also depends on the type of disease. Most often, Billroth-1 and 2 are prescribed for stomach ulcers or cancer. Before the operation, the size of the excised area is estimated. Next, a decision is made on the method of resection.

The Billroth technique is one of the most commonly used during gastrectomy. There are a number of differences between these techniques. They appeared at different times. However, Billroth-1, although it is the first of its kind, is still quite effective today.

History reference

Resection of the stomach according to Billroth was first successfully carried out on 01/29/1881. The author and performer of this technique is Theodor Billroth. This is a German surgeon, a scientist who was able to restore the patency of the gastrointestinal tract by performing an anastomosis of the lesser curvature of the stomach with the duodenum. The operation was performed on a 43-year-old woman who suffered from stenosing type cancer. Pathology developed in the pyloric part of the stomach.

In the same year, in November, the first successful resection for peptic ulcer of the pylorus was performed using the same technique. The patient survived after such a surgical intervention. This technique was called Billroth-1. After the first operation, the German surgeon himself began to create a connection not in the small, but in the large curvature of the stomach.

Of course, the technology of that time could not be called flawless. At the end of the 19th - beginning of the 20th century, the gastroduodenal suture line caused a lot of trouble when using the presented technique. Often they were unsuccessful. During this time, 34 patients were operated according to Billroth-1. 50% of patients died.

To reduce mortality due to suture failure, it was proposed in 1891 to suture the end of the stomach, creating a connection with the duodenum and the posterior wall of the stomach. A little later, the anastomosis began to be created with the anterior wall of the stomach. It was also proposed to mobilize the duodenum (in 1903). This maneuver was invented by a scientist, surgeon Kocher.

As a result, in 1898, at the Congress of German Surgeons, 2 main methods of stomach resection according to Billroth-1 and 2 were established.

Features and benefits of Billroth-1

To understand how Billroth-1 differs from Billroth-2, you need to consider the features of each of these operations. They are used for various diseases of the stomach. The first technique is distinguished by the circular type of excision of the gastrointestinal tract, which are affected by pathology. Subsequently, during this operation, an anastomosis is applied. It is located between the duodenum and the rest of the stomach and is created according to the ring-to-ring principle.

In this case, the anatomy of the esophagus remains unchanged. The preserved part of the stomach performs a reservoir function. During resection of the stomach according to Billroth-1, the contact of the mucous membranes of the intestine and stomach is excluded. The advantages of this technique are:

1. The anatomical structure does not change. The work of the gastrointestinal tract and its digestive tract is preserved.
2. Technically, such a surgical intervention is much easier to perform. In this case, the operation is performed in the upper part of the peritoneum.
3. According to statistics, dumping syndrome (impaired bowel function) after the intervention presented is very rare.
4. There is no syndrome of formation of adductor loops.
5. The method does not lead to the subsequent development of hernias.

It is also worth noting that the path that food passes after the operation becomes shortened, but the duodenum is not excluded from it. If you manage to leave some part of the stomach, it will be able to perform its natural function - to be a reservoir for food.

This operation is quite fast. The consequences are much better tolerated by the body. It also eliminates the risk of peptic ulcers at the site of the anastomosis.

Billroth-1: disadvantages

Billroth-1 and 2 operations also have certain disadvantages. They must be taken into account when choosing a technique for surgical intervention. During the operation according to Billroth-1, duodenal ulcers can be observed.

With this method of surgical intervention, it is not possible to qualitatively mobilize the intestine in all cases. This is necessary to create an anastomosis without suture tension. Especially often this problem occurs in the presence of duodenal ulcers that penetrate into the pancreas. Also, severe scarring, narrowing of the lumen of the intestinal passage can lead to the inability to properly mobilize the duodenum. The same problem occurs with the development of ulcers in the proximal stomach.

Some surgeons insist on performing a Billroth-1 resection with great enthusiasm, even if there are a number of unfavorable conditions for its implementation. This greatly increases the likelihood of suture failure. Therefore, in some cases, it is required to abandon the Billroth-1 operation. In the presence of significant difficulties, it is better to give preference to surgical intervention according to the second method.

It is extremely important that the technique of the surgeon who will perform the operation be carefully honed and perfected as much as possible. Although Billroth-1 is considered an easier, faster technique, it is performed exclusively according to strict indications. The decision to conduct it is made only in the presence of certain factors and the absence of certain obstacles.

In some cases, for this operation, it is required to mobilize not only the duodenum, but also the spleen and intestinal stump. In this case, it is possible to create a seam without tension. Extensive mobilization greatly complicates the operation. This unnecessarily increases the risk during its implementation.

It is also worth noting that Billroth-1 resection is not performed during the treatment of gastric cancer.

Billroth-2 technique

Considering briefly Billroth-1 and 2, it is worth paying attention to the second type of resection technique. During this operation, the part of the stomach remaining after excision is sutured using the overlay method from the posterior or anterior gastroenteroanastomosis. Billroth-2 has many modifications.

Anastomosis in this case is superimposed on the principle of "side to side". The rest of the organ is sutured to the jejunum. Frequently used modifications of Billroth-2 are the methods of closing the stump of the stomach, suturing its remaining part with the jejunum, etc. This technique is used in that case. If there are contraindications to Billroth-1.

It is worth noting that Billroth-2 is prescribed for ulcers and stomach cancer, and other diseases of the organ. In this case, the organ is resected in the amount indicated by the state of the stomach, the type of disease. The organ is sewn after excision in a special way. With some diagnoses, this operation is the only way out. Billroth-2 allows you to make the gastrointestinal tract passable.

Billroth-2: positive and negative sides

Resection according to Billroth-1 and 2 has a number of positive and negative qualities. The second method has a number of advantages. When performing Billroth-2, it is possible to carry out an extensive resection without stretching the gastrojejunal sutures. If a patient is diagnosed with a duodenal ulcer, when performing an operation using this technique, the occurrence of a peptic ulcer at the junction occurs much less frequently.

Also, if a patient has a duodenal ulcer, which is accompanied by the presence of gross pathological defects in the duodenum, it is much easier to suture the organ stump than to create an anastomosis with the stomach.

If a duodenal ulcer is found in a patient, which is not subject to resection, it becomes possible to restore the patency of the gastrointestinal tract only with the help of Billroth-2. These are the main advantages of the presented method.

The disadvantages of the method are the following:

• increased risk of developing dumping syndrome;
• the operation is accompanied by difficulties, requires more time;
• there is a possibility of occurrence;
• in some cases, after Billroth-2, an internal hernia occurs.

However, this technique has its place. Billroth-2 is sometimes the only possible solution for the development of certain pathologies. Therefore, doctors carefully study the features of the course of the disease before prescribing one or another type of operation.

Differences in methods

It should be noted that the Billroth-1 and 2 techniques are significantly different. The junction in the first case is called "ring to ring". With Billroth-2, the anastomosis looks like "side to side". Accordingly, due to such an intervention, complications may develop in both cases. However, in both cases they are not the same.

It should be noted that the degree of expression of the dumping syndrome in Billroth-2 is more pronounced. The work of the stomach itself and the entire gastrointestinal tract after these operations is also different. With Billroth-1, the patency of the intestinal tract is maintained. However, this operation is not performed for stomach cancer, extensive ulcers and gross changes in the tissues of the stomach. In these cases, the Billroth-2 technique is shown.

Indications for carrying out Billroth-1 are the following conditions:

• Peptic ulcers of the stomach. This is the least controversial indication. In this case, resection of 50-70% of the stomach gives a good result. In this case, an addition in the form of a stem vagotomy is not required. The only exception is the operation for prepyloric ulcers and pathologies in the area of ​​the vertebrae in the presence of increased secretion of the stomach.
• Duodenal ulcers resection of 50-70% of the stomach is indicated, but only when using stem vagotomy.

Indications for carrying out Billroth-2 can be gastric ulcers, which have almost any localization. If half of the stomach is excised, a stem vagotomy is used.

Also, with stomach cancer, the only possible option for excising the affected tissue is Billroth-2. This is due to the possibility of performing an extensive resection not only of the stomach, but also of regional lymph nodes and duodenum. In this case, the occurrence of obstruction of the anastomosis is less likely than in the case of the first technique.

Modifications of the first technique

The differences between Billroth-1 and 2 are significant. These methods have modern modifications. The second method has more of them. With Billroth-1, the modifications differ only in the way the anastomosis is created. The fact is that the size of the diameters that are interconnected are different. This leads to a number of difficulties. Only with a very limited resection in the pyloric part of the stomach, which is carried out according to the Pean method, can it be connected to the duodenum "end to end" without prior suturing or narrowing.

One of the main modifications of Billroth-1 is the Gaberer technique. It allows you to eliminate the discrepancy between the diameters of the organs after resection without suturing part of the lumen of the stomach stump. In this case, a corrugated seam is applied. An end-to-end anastomosis can then be performed. The Gaberer method has been significantly improved today. Previously, it often led to narrowing of the anastomosis and its obstruction.

There are other ways to narrow the lumen. They differ from the Gaberer method in the way in which the corrugated seams are created.

Modifications of the second technique

During Operation Billroth-2, many modifications are applied. The main one is the method proposed by the Hofmeister-Finsterer. Its essence is as follows. Part of the stomach after excision of damaged tissues is connected according to the "end to side" principle. In this case, the width of the anastomosis should be 1/3 of the total lumen of the gastric stump.

The connection is then fixed in an artificially created lumen transversely. The adductor loop of the jejunum in this case is sutured with two or three sutures. They are performed according to the type of nodules in the stump. This feature helps prevent food from entering the truncated section of the gastrointestinal tract.

Other Resection Improvements

Having considered the differences between Billroth-1 and 2, it should be noted that although there is a big difference between these methods, they have been significantly improved since their discovery. Therefore, today the resection procedure is carried out with less risk for the patient. In specific conditions, certain methods are used.

So, surgeons can perform a distal excision of the diseased part of the organ with the formation of an artificial pyloric sphincter. In some cases, in addition to this, an invagination valve is installed. It is formed from the tissues of the mucous membrane.

Resection can be carried out with the creation of a pyloric sphincter, such as. An artificial valve may be formed at the entrance to the duodenum. At the same time, the pyloric sphincter is preserved.

Sometimes distal resection may be subtotal. In this case, jejunogastroplasty of the primary type is performed. Some patients are shown subtotal, complete resection of the stomach. In this case, an invagination valve is formed on the outlet section of the jejunum.

If the patient is shown a resection of the proximal type, an esophagogastroanastomosis and an invagination valve are installed. Existing techniques allow the most accurate resection of the diseased part of the organ. In this case, the risk of complications will be minimal.

Having considered the differences between Billroth-1 and 2, one can understand the basic principles of such surgical interventions. Both methods have been greatly improved. Today they are used in a modified form.

Resection of the stomach is surgical method treatment of diseases of the stomach and duodenum. The principle of resection is to remove part of the stomach, followed by restoration of the integrity of the digestive tract due to the gastrointestinal anastomosis (connection).

The method of resection depends on the location of the pathological process, the type of disease (stomach cancer, ulcer), the size of the excised area of ​​the organ.

The operation is performed in two main ways: Billroth I and Billroth II.

Gastric resection at the Assuta clinic is the right way choice of treatment option.

The advantages of going to the hospital are obvious:

1. High professionalism of the medical staff - the operation is carried out by the best experts in the declared profile.
2. The ability to choose an attending physician is a significant bonus practiced by the Assuta private medical complex.
3. Advanced equipment, which the clinic purchases one of the first in the world.

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Resection of the stomach according to Billroth 1

Resection of the stomach according to Billroth 1 is a circular excision of the antral and pyloric sections of the stomach, the imposition of an anastomosis between the stomach stump and the duodenum in an end-to-end manner. Currently, Israeli surgeons use this method with the modification of Gaberer II.

Advantages of stomach resection according to Billroth 1:

1. The normal anatomy and functions of the digestive system do not change, since the anastomosis of the stomach stump with the duodenum is performed. This favors the digestion of food from the stomach into the intestine, mixing with pancreatic, duodenal and bile secretions. At resection according to Billroth 2 the mixing process takes place in the jejunum. But due to the absence of the pylorus during resection according to Billroth 1, the transition of food from the stomach to the duodenum, and then to the jejunum, is carried out quickly. Therefore, mixing is actually done in the jejunum. In this case, the differences are more theoretical.
2. Technically resection of the stomach according to Billroth 1 easier to perform. In addition, all surgical intervention is performed in the upper part of the abdominal cavity.
3. Dumping syndrome develops much less frequently after this operation.
4. This type of surgery does not increase the likelihood of developing internal hernias or afferent loop syndrome.

Disadvantages of stomach resection according to Billroth 1:

1. This type of operation often provokes the appearance of anastomotic ulcers, duodenal ulcers.
2. Not in all cases, it is possible to sufficiently mobilize the duodenum to form an anastomosis with the stomach, so that there is no tension on the suture line. This causes duodenal ulcers, severe cicatricial deformity and narrowing of the intestinal lumen, ulcers of the proximal stomach. In some situations, mobilization of the spleen and stomach stump is also required, which complicates the surgical intervention and unjustifiably increases its risk.
3. Resection of the stomach according to Billroth 1 is not performed for the diagnosis of gastric cancer.

Resection of the stomach according to Billroth

Resection of the stomach according to Billroth 2 differs in that the stump of the organ is sutured with the imposition of a posterior or anterior gastroenteroanastomosis. Billroth 2 also has many modifications according to the methods of suturing the jejunum to the stomach stump, closing the stomach stump, etc.

There are more indications for Billroth 2 resection: gastric ulcers of the proximal, distal and middle third, peptic ulcers.

Advantages of stomach resection according to Billroth 2:

1. An extensive resection of the organ is carried out without stretching the gastrojejunal sutures.
2. With a duodenal ulcer, peptic ulcers of the anastomosis occur less frequently after surgery.
3. With duodenal ulcer with rough pathological changes of the duodenum, suturing of the stump is easier than anastomosis with the stomach.
4. In case of an unresectable duodenal ulcer, after performing a Finsterer-Bancroft-Plenk “on-off” resection, only Billroth 2 resection can restore the patency of the digestive system.

Disadvantages of stomach resection according to Billroth 2:

1. The risk of developing a dumping syndrome increases.
2. Possible, although rare complications are afferent loop syndrome and internal hernia.

Gastric resection surgery: indications, types of examinations, techniques

There are absolute indications for gastric resection:

• suspicion of malignancy of the ulcer;
• pyloric stenosis;
• repeated gastrointestinal bleeding.

Relative indications for resection of the stomach - ulcer perforation, long-term non-healing ulcer.

Before surgical treatment, a number of examinations are carried out at the Assuta clinic: esophagogastroduodenoscopy with biopsy, X-ray contrast examination, ultrasound, CT scan, blood tests for tumor markers, MRI, scintigraphy.

Preoperative chemotherapy and radiation therapy are used to prevent metastasis and stabilize tumor growth.

The technique of resection of the stomach for gastric cancer and peptic ulcer has its own differences. If the diagnosis is peptic ulcer, then 2/3 - 3/4 of the body of the stomach with the pyloric section are removed. For stomach cancer, a more extensive operation is performed, with the removal of the greater and lesser omentum, regional lymph nodes.

During surgery, an urgent biopsy is performed, according to the results histological examination surgeons may decide on an extended operation.

If the tumor is located in the cardial part of the stomach with the spread of the malignant process to the esophagus, the surgeons of the Assuta clinic perform a proximal resection of the stomach. The cardial part of the organ with a part of the esophagus is resected. The integrity of the digestive tube is restored by stitching the stump of the esophagus with the stump of the stomach.

The operation lasts 120-240 minutes. Pain relief is general anesthesia. Hospitalization - 10 - 14 days.

Next steps complex treatment Israel will have radiotherapy and chemotherapy.

With advanced stages of gastric cancer, resection is not performed. Palliative treatment is prescribed - chemotherapy, radiotherapy, immunotherapy.

Gastrectomy operation in Assuta clinic

This surgical procedure is the most common and effective method treatment of malignant tumors of the stomach.

Total removal of the organ is performed with a large stomach tumor, with localization of the malignant process in the middle third of the organ, with a widespread process, with cancer recurrence. Rarer indications include gastric bleeding, peptic ulcer, benign tumors and a number of other diseases.

Operation gastrectomy: why Israeli medicine

Gastrectomy is a difficult and serious operation with a number of risks. According to statistics, in the early postoperative period, mortality among patients is ten percent. The use of modern technologies and the performance of operations by experienced highly qualified surgeons improve the prognosis. Assuta Clinic can offer:

• services of the highest level specialists with knowledge of modern gastrectomy techniques;
• the latest diagnostic and treatment equipment;
• technologies that minimally injure the body, which shortens the recovery period.

The operation of gastrectomy is divided into 3 types:

1. Distal subtotal gastrectomy, in which part of the stomach adjacent to the intestines is removed, and possibly a segment of the duodenum.
2. Proximal subtotal gastrectomy involves the removal of the lesser curvature of the stomach, lesser and greater omentum, gastro-pancreatic ligament with a group of regional lymph nodes.
3. A total gastrectomy is an operation in which the entire stomach is removed. The esophagus is sutured to the small intestine.

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Preparing for a gastrectomy

The diagnostic spectrum may include the following procedures:

1. Laboratory tests (blood tests, fecal occult blood tests).
2. Endoscopic diagnostics by means of a flexible probe.
3. Computed tomography or PET-CT.
4. X-ray examination of the gastrointestinal tract using barium suspension.

Contraindications to gastrectomy: distant metastases of cancer, a serious condition of the patient associated with cardiac, renal or respiratory failure, a violation of blood clotting.

Gastrectomy: the course of the operation

During this surgery, the patient is under general anesthesia. The operation is performed by abdominal or combined access.

When gastric cancer spreads to the esophagus, Assuta clinic surgeons use a combined approach: left-sided lateral thoracotomy in combination with laparotomy.

With infiltrative tumor growth, undifferentiated tumors, total damage to the stomach, cancer with regional metastasis, laparotomy is used - abdominal access.

Gastrectomy is performed in compliance with the rules of ablation. On the initial stage revision of the abdominal organs. When a malignant tumor is located in the upper and middle sections of the stomach with invasion of the esophagus, the left pleural cavity is opened and the diaphragm is crossed. Removal of the stomach is performed in a single block with small and large omentums, fatty tissue, ligamentous apparatus, regional lymph nodes, part of the esophagus. After cutting off the duodenum, an anastomosis is performed between the stump of the esophagus and the jejunum.

A laparoscopic approach is also used for gastrectomy. It is much less traumatic for the patient's body. The disadvantages include the difficulty in removing lymph nodes near the vessels and vital organs.

Endoscopic gastrectomy using the da Vinci robot system provides high precision, allowing you to operate in hard-to-reach areas.

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Postoperative period

Among possible complications note:

• thrombosis;
• bleeding;
• infections;
• preservation of foci of malignant formation;
• damage to neighboring vessels;
• nutrient deficiency;
• inability to take a normal amount of food;
• anemia;
• dumping syndrome (a condition in which eating can cause vomiting, nausea, diarrhea, and sweating).

After gastrectomy surgery, the patient may need the following care and medical support:

1. If you are unable to take an adequate amount of fluid, the introduction is made intravenously.
2. A nasogastric tube is inserted through the nose into the stomach (the saved part of it) in order to divert secreted digestive juices until the intestines begin to function normally.
3. A feeding catheter is inserted into small intestine before switching to a normal diet.
4. There may be a need for intravenous administration antibiotics, in catheterization Bladder, in the application of an oxygen mask.

Nutrition after gastrectomy

The following changes will need to be made to the diet:

1. Cut down on portion sizes.
2. Increase the frequency of meals up to 5-6 times a day, chewing thoroughly and taking with weak solutions of citric acid. Three and four meals a day leads to anemia and impaired bowel function.
3. Refrain from eating large amounts of fatty foods.
4. To ensure a healthy diet, you need to take dietary supplements.

Patients who have undergone gastric ectomy (1-1.5 years after surgery) are recommended a hyposodium (low-salt) diet, which will contain a large amount of protein, limited fat and a very small amount of easily digestible carbohydrates. Mechanical and chemical irritants of the mucous membrane of the gastrointestinal tract should be limited: spices, marinades, chocolate, pickles, alcohol, canned food, carbonated, hot and cold drinks. Basically, the diet should consist of boiled or steamed food.

Application for treatment