The technique of stomach resection for ulcerative disease. Stomach resection technique Distal subtotal stomach resection via bilrota 2

but) Indications for bilrhot stomach resection 1:
- Planned / Absolute Indications: Stubborn or complicated stomach ulcer, resistant to conservative therapy, or extensive (amputizing) ulcer duodenal gut. - Relative readings: Malignant neoplasm of the distal stomach department.
- Contraindications: Diffuse-type distal stomach cancer (Lauren classification).
- Alternative operations: Combined resection, Bilroty II, Gastrectomy.

b) Preoperative preparation:
- Preoperative Studies: Transabdominal and Endoscopic ultrasound procedure, Endoscopy with biopsy, possibly radiography upper departments Gastrointestinal tract, computed tomography.
- Preparation of the patient: Nastogastric probe, central veins catheterization.

in) Specific risks informed by the patient's consent:
- Damage to the spleen, splenectomy
- bleeding (2% of cases)
- inconsistency of anastomosis (less than 5% of cases)
- recurrent anastomosis ulcer or ulcer
- Violation of food (5-15% of cases)
- dumping syndrome (5-25% of cases)
- damage to the bile duct (less than 1% of cases)
- Damage to the middle colonical artery
- Pancreatitis (1% of cases)

d) Anesthesia. General anesthesia (intubation).

e) Patient position. Lying on the back.

e) Access for bilot stomach resection I. Ultra-medium laparotomy.

g) Stages of the operation:
- Access
- The volume of resection
- Disession of the Big Self
- separation of the gland from the transverse colon
- Dissection behind the stomach
- Skeletonia of small curvature
- Crossing the right gastric artery
- proximal skeletalization of small glad
- allocation of the left gastric artery
- Crossing the left gastric artery
- Mobilization of the duodenum (Kohker maneuver)
- resection of the distal part of the stomach
- Blood seam sheaving
- rear wall of gastroduodenostomy
- the front wall of gastroduodenostomy
- Gastroduodenostomy "End in Side"
- Closure of hard cultivation of duodenal

h) Anatomical features, serious risks, operational techniques:
- The bottom of the stomach and spleen (short gastric vessels), a large curvature and a cross-colon / her mesentery, the distal depth of small curvature and the sepiecnodent-beaten ligament, as well as the posterior wall of the stomach and pancreas are close to each other.
- There are several important vascular bonds: between the left gastric artery and the right gastric artery from the hepatic artery - along the small curvature; between the left gastrointestinal artery from the spleen artery and the right gastrointestinal artery from the gastrointestinal artery - along the great curvature; Between short gastric arteries from the spleen artery - in the area of \u200b\u200bthe bottom of the stomach. An important venous trunk along the small curvature (Vienna Vienna of the stomach) flows into a gala vein.
- Warning: separation of vessels.
- Approximately 15% of cases in a small seller, an additional left hepatic artery is found, which comes from the left gastric artery.
- WARNING: Be careful damage to the hepatic artery when crossing the right gastric artery; After conspiring this vessel, first make sure the ripples inside the hepatic and duodenal ligament at the liver.

and) Specific complications:
- Damage to the bile duct: impose the primary seam by the absorbable material after administration of the T-shaped tube.
- Damage to the spleen: Try to preserve the spleen by hemostasis of electrical / sapphire / argon-plasma coagulation and the imposition of hemostatic material.

to) Postoperative care After resection of the stomach by bilrot i:
- Medical care: Remove the nasogastric probe for 3-4 days, remove drainage for 5-7 days.
- Resumption of nutrition: Little liquid pharynx from 4-5 days, solid food - after the first independent chair.
- intestinal function: enema from the 2nd day, orally laxatives from the 7th day.
- Activation: Immediately.
- Physiotherapy: breathing exercises.
- Permanent period: 2-4 weeks.

l) Operational Recreation Technique of Bilrot I (Gastroduodenostomy):

1. Access. Access through the top-end laparotomy cut with a possible expansion up and down. For patients with obesity, an alternative is the right reduced incision.

2. The volume of resection. The distal resection of the stomach includes the removal of a distal half of the stomach along with the gatekeeper; The edge of the resection is located between the ascending and downstream branch of the left gastric artery - in a small curvature and the venue of the branches of the left and right gastrointestinal artery - in great curvature. If the skeletonization can be performed close to the stomach, while preserving gastrointestinal vessels, then with a malignant tumor, it is necessary to fully sabilize a large and small gland in accordance with the location of lymphatic reservoirs. In this chapter, an example for illustration of the operation is the case of a stomach cancer. Intervention includes full removal The distal part of the stomach and the corresponding lymphatic collectors. With ulcers, only the stomach is removed without surrounding lymphatic tissue.

3. Disession of Big Salna. This dissection is performed only with cancer and begins with the separation of the large gland from the transverse colon with the intersection of the duodenum and rigor to the right and gastrointestinal and spray-rigs - on the left. This allows you to rotate the gland to the top and separate it from the mesentery of the transverse colon with a neat tension.

4. Department of the gland from the transverse colon. The separation of the large-seater from the transverse sequence is made by bimanual traction of the large gland in the cranioventral direction and the cross-colon - in the venturound direction, followed by the dissection by a scalpel or an electrical circuit. Small vessels intersect between ligatures. The gland is fully separated from the cross-colon, with a continuation of the dissection on the surface leaflet of the flimberry of the transverse garrium to the gland bag.

5. Dissection behind the stomach. The dissection of the large gland and the front leaflet of the mesentery of the transverse colon over the surface of the pancreas is stupidly performed. Upon completion of the dissection, pancreas and mesente vessels are free from the peritoneal cover. Now the stomach can be shifted rapidly, thereby completing the dissection from the side of great curvature.

6. Skeletonia of small curvature. The skeleton of small curvature is carried out at the bottom surface to the esophageal hole of the diaphragm. With ulcers, skeletalization is performed close to the stomach, with cancer it includes a complete removal of a small gland. It is recommended to skeleton a small curvature from the bottom up. It was shown that it is convenient to start from the duodenum of the gatekeeper.

7. Crossing the right gastric artery. After the dissection of the duodenum and colon, the gatekeeper is detected and the overheat clamp is performed for it. The clamp should go to the proximal to the liverodznodenty-alert ligament, at the place of revering of the right gastric artery. Outping the second Overwheat clamp, this vessel can be crossing between two clips under the control of vision or palpation. This greatly facilitates access to small curvature, preventing damage to the portal vein, hepatic artery or general bile duct.

8. Proximal skeletoning of small glad. The skeletonism continues to the terminal department of the esophagus. In this area, the small gland is often so thickened that the detection of the border of the stomach is possible only by palpation. The edge of the stomach is best determined between the big and index finger; A small gland is separated by a climb under the control of the index finger and intersects between ligatures. The skeletonization of small curvature completes the imposition of a seam-holder, which is superimposed by 1-2 cm distal than esophageal and gastric transition.

9. Healing of the left gastric artery. The decision to cross the left gastric artery depends on the underlying disease. Whereas when cancer, this vessel intersects in the ventral trunk with the implementation of the ventilation lymphadenectomy, peptic disease It is important to cross the downstream branch and maintain the ascending branch of the artery. Here is an option to perform an operation when cancer of the stomach. After turning the stomach, the vascular bundle is easily palpable between the index and middle fingers of the left hand of the surgeon. The accompanying coupling and lymphatic tissue intersect separately and are respected. The remaining vascular beam consisting of the left gastric artery and veins is easily stretched by the branch of the stomach of venturound.

10. Crossing the left gastric artery. Left gastric artery and vein intersect between the forceding clamps and are tied with firmware. In cases requiring lymfadenectomy, at this stage the dissection of curls of curls begins.

11. Mobilization of the duodenum (Manever Kohler). The restoration of the continuity of the gastrointestinal tract (Gastroduodenostomy according to Bilrot I) requires a wide mobilization of the duodenum (Kohher's maneuver). To do this, the duodenum is captured by a napkin and shall be assigned to medially, and the parietal peritonean dishes laterally with scissors. Dissection continues in the cranial direction to the hepatic duodenal ligament, and in the caudal direction - to the lower bending of the duodenum. Dissection is usually blurred and facilitated by slightly siping the duodenum. Small vessels can be coagulated by bipolar tongs. After the discharge is completed, the rear surface of the pancreas and the right wall of the lower hollow vein are exposed.

12. Resection of the distal part of the stomach. The proximal resection is performed along the line connecting the point located on 1-2 cm distal than cardia in small curvature, with a place of arterial anastomosis at great curvature. These guidelines are marked by shuts. Recreation with recreation of small curvature can be performed by a linear crosslinking device. The distal part of the stomach is closed by a Kochher clamp. The distal edge of resection is located approximately 1 cm distal than gatekeeper.

When preparing for gastroduodenostomy "End in Side", the proximal duodenal culture can be closed tightly. For gastroduodenostomy "End at the end", the lumen of the cult is usually left open. The distal part of the drug of the stomach is temporarily closed in moistened in antiseptic solution gauze tampon and fixed with a linen clamp.

13. Sheathing. After removing the resected preparation, the bracket line is trimmed by separate seams (3-0 PGA) with a segment leaving about 4 cm long on a large curvature. The distal part of the cult is again respected between the seams-keys to the size of the duodenal loss and is prepared for an anastomosis "End to the end".

14. Rear wall of gastroduodenostomy. Single-row anastomosis is performed by individual seams through all layers (3-0 PGA). The distance between the seams and the stitch width are 0.6 cm.

All materials on the site are prepared by experts in the field of surgery, anatomy and profile disciplines.
All recommendations are approximate and without advising the attending physician not applicable.

Recreation of the stomach is an operation to remove part of the stomach, affected by chronic pathological process, followed by the formation of anastomosis (connecting various digestive tube departments) to restore the adequate passage of food.

This operation is considered severe and traumatic and, undoubtedly, this is an extreme measure. However, it is often for the patient. It is the only way to cure a number of diseases, conservative treatment which clearly will not give the result.

Today, the technique of this operation is thoroughly designed and simplified, and therefore has become more accessible to surgeons and can be performed in any general merger branch. The resection of the stomach is now saving those patients who were previously considered inoperable and incurable.

The method of resection of the stomach depends on the location of the pathological focus, histological diagnosis, as well as the size of the affected area.

Indications

development of stomach cancer

Absolute readings:

• Malignant tumors.
• Chronic ulcers with suspicion of malignation.
• Decompensated stenosis of the gatekeeper.

Relative readings:

1. Chronic stomach ulcers with a bad response to conservative treatment (within 2-3 months).
2. Benign tumors (most often multiple polyposes).
3. Compensated or subcompensated stenosis of the gatekeeper.
4. Obesity of severe.

Contraindications

Contraindications to surgery are:

• Multiple remote metastases.
• Ascites (arising, as a rule, due to the liver cirrhosis).
• Open shape of the pulmonary tuberculosis.
• Hepatic and renal failure.
• Heavy flow of diabetes.
• Heavy condition of the patient, cachexia.

Preparation for the operation

If the operation is carried out in a planned manner, a thorough examination of the patient is prescribed.

1. General blood and urine tests.
2. Study of the coagulation system.
3. Biochemical indicators.
4. Blood type.
5. Fibrogastrudodenoscopy (FGDS).
6. Electrocardiogram (ECG).
7. Lung radiography.
8. Ultrasound examination of the abdominal organs.
9. Inspection therapist.

Emergency Recreation is possible in case of strong bleeding or sprinkling ulcers.

Before the operation, the cleansing enema is used, the stomach is washed. Operation itself, as a rule, lasts no more than three hours with the use of common anesthesia.

How is the operation?

Upper median laparotomy is produced.

The resection of the stomach consists of several mandatory stages:

• I Stage - the audit of the abdominal cavity, the determination of operation.
• II - mobilization of the stomach, that is, giving it mobility by cutting off the ligaments.
• III stage - directly cut off the necessary part of the stomach.
• IVTAP - Creation of anastomosis between stomach and intestines.

After completing all stages, the operating wound is sewn and drained.

Types of resection of the stomach

The type of resection in a particular patient depends on the testimony and location of the pathological process.

Based on how the volume of the stomach is planned to be removed, the patient can be carried out:

1. Economical resection, those. Removal from one third to half of the stomach.
2. Extensive, or typical resection: Removal of about two thirds of the stomach.
3. Subtotal resection: Removal 4/5 of the volume of the stomach.
4. Total resection: Removal of more than 90% stomach.

On the localization of the excised department:

• Distal resection (Removing the end portion of the stomach).
• Proximal resection (Removing the input stomach, its cardiac part).
• Middle (The gastric body is removed with the leaving of its input and output departments).
• Partial (Deleting only the affected part).

In the form of the formable anastomosis distinguish 2 basic methods - resection BilrotaI.and BilrotaII.As well as their various modifications.

Bilrota operationI.: After removing the output department, the stomach culture is connected by a direct compound "The output end of the cult is the entrance end of the duodenum." Such a compound is most physiologically, but technically such an operation is quite complex, mainly due to poor mobility of the duodenum and the inconsistency of the diameters of these organs. It is currently applied rarely.

Bilrote resectionIi:it provides for the stomaching of the stomach and duodenal culture, the formation of anastomosis "side in side" or "end in the side" with a transsive intestine.

Resection of stomach ulcers

For ulcerative disease, in order to avoid relapses, they seek to rescue from 2/3 to 3/4 of the body of the stomach along with the antral and pyloric department. Gastrin hormone is produced in the anthral department, which increases chlorogenic acid products in the stomach. Thus, we produce anatomical removal of a zone that promotes increased acid secretion.

but operational intervention Regarding the stomach ulcers, it was only popular until recently. The replacement of resection began to coming organ-bearing operational interventions, such as excision wandering nerve (Wagotomy), which regulates hydrochloric acid products. This species Treatment is applied in those patients who have increased acidity.

Stomach resection during cancer

With a confirmed malignant tumor, bulk resection (as a rule, subtotal or total), with removal of a part of a large and small gland, to prevent the recurrence of the disease. It is also necessary to remove everything the lymph nodesPruting the stomach, as they may contain cancer cells. These cells can be metastable to other organs.

The removal of lymph nodes extends significantly and complicates the operation, however, ultimately, it reduces the risk of cancer recurrence and prevents metastasis.

In addition, when the germination of cancer is detected into neighboring organs, it often faces the need for combined resection - removal of the stomach with part of the pancreas, esophagus, liver or intestines. Recuracy in these cases is desirable to make a single block in compliance with the principles of ablastics.

Longitudinal resection of the stomach

longitudinal resection of the stomach

Longitudinal resection of the stomach (PRG, other names - "Dummy", sleeve, vertical resection) - it surgery to remove the lateral part of the stomach, accompanied by a decrease in its volume.

Longitudinal resection of the stomach is a relatively new method of resection. For the first time, this operation was carried out in the United States about 15 years ago. The operation is rapidly gaining popularity worldwide as the most effective method Treatment of obesity

Although, with the PRG and remove a significant part of the stomach, all the natural valves of it (the Sphinteer of the cardiac department, the gatekeeper) is left, which allows you to preserve the physiology of digestion. The stomach of the bulk bag is converted to a fairly narrow tube. It occurs quite rapid saturation of relatively small portions, as a result, the patient consumes much less food than before the operation, which contributes to the resistant and productive weight loss.

Another important feature of the PRG is that a plot is removed in which Grethin hormone is produced. This hormone is responsible for the feeling of hunger. With a decrease in the concentration of this hormone, the patient ceases to experience a constant craving for food, which again leads to weight loss.

Work digestive tract After the operation quickly returns to its physiological norm.

The patient can count on weight loss equal to about 60% of excess weightwho had in front of the operation. PZHR becomes one of the most popular anticipation operations and diseases of the digestive tract.

According to the reviews of patients who have undergone Prge, they literally began new life. Many who waved at themselves, for a long time unsuccessfully trying to lose weight, gained confidence in themselves, began to actively play sports, set up a personal life. The operation is performed, as a rule, the laparoscopic method. Only a few small scars remain on the body.

Laparoscopic stomach resection

This type of operations is also called the "minimum intervention surgery". This means that surgical intervention is carried out without larger cuts. The doctor uses a special tool called Laparoscope. After a few punctures in abdominal cavity Surgical instruments are introduced, which the operation under the control of laparoscope itself is performed.

A specialist who has a lot of experience, with the help of laparoscopy can remove some part of the stomach or entirely the entire organ. The stomach is removed through a small incision no more than 3 cm.

Data appeared on carrying transvaginal laparoscopic resection in women (the stomach is removed through the incision into the vagina). In this case, no scars on the front abdominal wall It does not remain.

The resection of the stomach, carried out with the help of laparoscopy, undoubtedly has great advantages over the open. It is characterized by less pronounced pain syndrome, easier under the postoperative period, less postoperative complicationsas well as a cosmetic effect. However, this operation requires the use of modern crosslinking equipment and the presence of the surgeon experience and good laparoscopic skills. Typically, laparoscopic resection of the stomach is carried out with the complicated flow of peptic ulcer and the ineffectiveness of the use of anti-rich drugs. Laparoscopic resection is also the main method of carrying out longitudinal resection.

For malignant tumors Laparoscopic operation is not recommended.

Complications

Among the complications arising during the operation itself and in the early postoperative periodIt is necessary to highlight the following:

1. Bleeding.
2. Entering infection in the wound.
3. Peritonitis.
4. Thrombophlebitis.

IN led later The postoperative period may occur:

• Insolvency anastomosis.
• The appearance of fistulas in the place of the formedist.
• Dumping syndrome (discharge syndrome) is the most frequent complications After gastrectomy. The mechanism is associated with the rapid flow of insufficiently digested food into a ... so-called "food failure") and causes irritation of its initial department, reflex vascular reaction (decrease heart Emission and expansion of peripheral vessels). It is manifested immediately after eating with discomfort in epigastrics, harsh weakness, sweating, heartbeat, dizziness up to faint. Soon (after about 15 minutes), these phenomena gradually pass.
• If the rejection of the stomach was carried out about the peptic disease, it may happen to her relapse. Almost always recurrent ulcers Localled on the intestine mucous membrane, which goes to the anastomosis. The appearance of an anastomosis ulcers is usually a consequence of a poorly conducted operation. Most often, peptic ulcers are formed after the billet-1 operation.
• Recurney of malignant tumor.
• Weight can be observed. First, it is determined by a decrease in the volume of the stomach, which reduces the amount of food taken. And secondly, the patient seeks to reduce the amount of food eaten to avoid the emergence of undesirable sensations associated with dumping syndrome.
• When conducting resection on bilrhost II, the so-called syndrome leading loop, the basis of which is the emergence of violations of the normal anatomy-functional relations of the digestive tract. Manifested by sawing pains in the right hypochondrium and bile vomiting bringing relief.
• After surgery, iron deficiency anemia may be increasingly complicated.
• It is much less likely to meet B12 deficient anemia due to insufficient developing in the stomach of the CASL factor, with which this vitamin is absorbed.

Nutrition, diet after stomach resection

Nutrition of the patient immediately after the operation is carried out parenterally: intravenously entered solutions, glucose and amino acid solutions.

In the stomach after the operation, a nastastric probe is administered to suck the contents of the stomach, and nutrient solutions can be introduced through it. The probe in the stomach is left for 1-2 days. Starting from third day, if the stomach is not observed stagnation, It is possible to give a patient not too sweet compotes with small portions (20-30 ml), the roster is about 4-6 times a day.

In the future, the diet will gradually expand, but it is necessary to take into account an important condition - the patient will be respected by a special diet balanced by nutrients and exclusive coarse labor-free food. The food that takes the patient should be thermally processed, consumed by small portions and should not be hot. A complete exclusion from the diet of salt is another condition of the diet.

The volume of portion of food is no more than 150 ml, and the reception frequency is at least 4-6 times a day.

This list presents Products, strict forbidden after operation:

1. Any canned food.
2. Fatty dishes.
3. Marinades and pickles.
4. Smoked and fried foods.
5. Sdob.
6. Carbonated drinks.

Stay in the hospital is usually two weeks. Full rehabilitation takes several months. In addition to compliance, the diet is recommended:

• Limitation physical Loads For 2 months.
• Wearing a postoperative bandage at the same time.
• Reception of vitamin and mineral biodeadows.
• If necessary, the reception of hydrochloric acid and enzyme preparations for improving digestion.
• Regular observation for early detection of complications.

Patients who suffered resection of the stomach should be remembered that the adaptation of the body to new digestive conditions can occupy 6-8 months. According to the reviews of patients who have undergone this operation, the first time is the most expressed weight loss, dumping syndrome. But gradually the body adapts, the patient acquires experience and a clear idea of \u200b\u200bwhich power and which products it transfers best.

Six months later, the year gradually comes back to normal, man returns to normal life. It is absolutely optionally after such an operation to consider itself disabled. The many years of experience of resection of the stomach proves: to live without a part of the stomach or even completely without a stomach.

In the presence of indications, the operation of the stomach resection is carried out for free in any separation of abdominal surgery. However, it is necessary to seriously approach the issue of choosing a clinic, because the outcome of the operation and the absence of postoperative complications is very large depends on the qualification of the operating surgeon.

Prices for resection of the stomach depending on the type and volume of operation fluctuate from 18 to 200 thousand rubles. Endoscopic resection will cost somewhat more expensive.

Sleep resection in order to treat obesity in principle is not included in the list of free medical care. The cost of such an operation is from 100 to 150 thousand rubles (laparoscopic method).

Video: Longitudinal stomach resection after surgery

Video: Laparoscopic Sleeve Stomach Recurge - Medical Animation

anonymously, man, 60 years old

Good day! Mama 59 years old, a stone was found on the ultrasound in the bustling bubble, after the endoscopy was held, not ulcers and not a tumor was found, she decided to operate LPraskopy, as a result, after surgery, the surgeon reported that when the cameras were introduced, they found a break The bubble bubble, he kept in a specially protective film, and the stone fell into the 12th gossip and formed a hitch, and a Bilrot 2 stream was fulfilled (2/3 of the stomach). Can you just tell it? If it is possible if this surgeon He says that he was a gap, and on ultrasound it did not show that why they immediately did not report such a serious surgery? And what are the consequences? Very worried .... thanks in advance

Hello. Yes, this situation is possible. Figure is formed between the bubble bubble and 12 persian intestine. You can not notice this. There was probably no gap of the gallbladder. If he were, it is peritonitis and absolutely different clinical picture. The doctor acted during the operation as it seems necessary in this situation and only it takes one or another method of operation based on the identified pathology. In your situation, he did as it should be. And I would have done so. If everything is done correctly, there are no consequences after the operation. After discharge, you will comply with the diet, the power mode and everything is normalized. Health to you.

anonymously

Thank you so much that you answered! Sorry, what I worry again, I just worry very worried about my mother ... The doctor said that the peritonitis was also, but I'm worried about what, she is already 5 days in resuscitation, and the temperature rises in the evening to 38, Does the doctor says that it is necessary to find an antibiotic who is suitable for her to remove these symptoms, did they not do the antibioticgram before surgery ??? I wanted to learn this normally, that after such an operation is so long in resuscitation? ... Sorry once again for these questions, I just worry very worried ... I can not personally ask the attending physician, as I live far abroad, and everything is passed through the dad, since the doctor does not respond to calls ... Thanks in advance ! All the best and strong health!

Your mother has this disease, I mean the DPK fistula with a bubble bubble, appeared yesterday. There should be no such thing. And what time "this system worked," and more accurately violated the usual work and bubble and DPK, which was certainly reflected on health. Removed gall-bubbleRemoved 2/3 of the stomach, left anastomoses. And now all this "design" must earn. The body should be used to it. If everything is done correctly (it is necessary to hope for it) and your mother's body will cope with the situation, then everything should go on the amendment. Such patients in resuscitation can be held for a long time. Why increase temperature - I do not know. It may be stagnant pneumonia, and possible complications After surgery (peritonitis is not a joke). Sorry, but I can't write in more detail, because I do not own all the information. Ask your dad so that it has a closer contact with a resuscator, and with the attending physician who should tell him that, yes, like.

anonymously

Hello, I wrote to you early on the issue of the bilrhroid operation 2 ... 19 days passed after surgery, my mother is still in the hospital, the seams were removed, but at the beginning of the seam there is a hematoma, which is constantly bleeding, temperature below 36, on average 35.5 .. and hemoglobin 86, she sticks the diet, but very weak, it is hard to rehabilitate, little by little, the question is tormented, from the moment the operation of the black and lifting chair (sorry for the details), the doctor says that this is the norm, they say so cleans the intestine, Mom herself does not cope, only with the help of the coupe, can it be? Very worried, as it is a district center, and often meets the negligence of doctors to their patients. Thanks in advance

The technique of bilrot II operation allows you to perform extensive resection of the stomach with the imposition of a gastroinny anastomosis "side in side". This technique is a prototype of subsequent numerous modifications of the stomach resection and in particular the method proposed by the gofmaster and the Finnermer.

The latter is as follows. After the upper median laparotomy, the stomach mobilization is mobilized and a 12-rosewood cult is treated accordingly. Then the surgeon proceeds to cut off the stomach and the formation of anastomosis. For which, the clamp is first removed from the pyloric department, all its contents are removed and the aspirator is satisfied, then two direct gastric flashes are superimposed on the stomach: one side of small, and the other - from the side of the big curvature so that their ends come into contact. Near them, the removed part of the stomach is taken to the crushing gastric clamp, after which it is in its edge, pre-stretching the stomach, the organ cut off the scalpel and remove the drug.

Next, go to the ears of the upper third of the resulting stomaching cult. Most professionals impose a two or three-row seams. The first seam makes around the gastric vows and tighten it. Then the same thread in the opposite direction passed through all the stratum of the stomach of the stomach continuous seam. Starting from the dessert site of the organ, according to its small curvature, a second row of nodular serous-muscular seams is carried out, fully immersing the previous row. The threads of the last seam are not cut, and taking them on the clip, are used as holding.

On the modern stage The insertion of the upper part of the stomach culture can be made by a two-row submersible seam using a special apparatus - the stomach stomach ears and applying P-shaped staples from tantalo-niobium wire as a suture. This approach allows to obtain a hermetic aseptic seam desired length and significantly reduce the operation time of the operation.

Having completed the embedding of the upper third of the stomach cult, surgeons are embarking on the formation of anastomosis. For what a pre-prepared short loop tochyan Carefully fade to the stomach cult so that its leading part corresponds to a small curvature, and the discharge is large. It should be noted that the length of the leading loop from the upper duodenal fold of the peritoneum before the outdated coordinates should not exceed 10 cm.

The intestine of the intestine is fixed to the stomach cult by overlaying several nodal silk seams for 3-4 cm above the location of the seam holders, and the discharge - one-sole suture to a large curvature. It is stomaching to the stomach so that the anastomosis line, the width of which necessarily should be at least 5-6 cm, passed strictly in the middle of the free edge of the intestinal loop.

Having finished the process of overlaying anastomosis, all napkins extract from the operating wound and produce a thorough revision of the abdominal cavity: they remove the bloodstand accumulated, they check the reliability and tightness of the ears of the culture of the 12-robes, assess the quality of blood vessel ligation.

Then the anastomosis is linked to the edges of the flushing of the cross-binding mesenter, and they, in turn, are fixed with 4-5 nodal seams to the wall of the stomach above the created fatal with such a calculation so that there are no large slots between the seams, due to the fact that the insufficient fixation is fraught with penetration of loops thin gut In the mesentery window with the development of their infringement. After an anastomosis is reduced, the cross-boring intestine is lowered back into the abdominal cavity and lay down the wound wound into the abdominal wound.

The resection of the stomach is a surgical operation at which part of the stomach is removed. The integrity of the digestive tract remains unchanged, the food passes through the gastrointestinal tract as usual as usual.

This is achieved through a special compound - gastrointestinal anastomose.

Theodore bilrotte was held the first successful resection of the stomach in 1889, which is why such resection worn his name. To date, it is trying to minimize operational cuts, laparoscopic methods are performed. surgical intervention Even during the most difficult operations.

The method of resection of the stomach largely depends on the type of disease, the localization of the pathological process, the size of the operated area of \u200b\u200bthe stomach.

There are several indications for stomach resection:

• repeated bleeding of the gastrointestinal tract;
• stomach cancer;
• malignation of ulcers or suspicion of it;
• punching of ulcers;
• stenosis of the gatekeeper;
• a peptic defect that does not heal for a long time.

Bilrot operation lasts about 2 hours. General anesthesia is used, the hospitalization of the patient after the operation of about 2 weeks, depending on the state of health.

Stomach resection Scheme Bilrot 1 and 2 - diagnostics before operation

Before proceeding and surgical treatment of the stomach, in Israel, a thorough diagnosis is carried out to identify all features of the disease.

Procedures that the doctor may appoint:

• inspection from a specialist - from $ 500;
• various tests blood - from $ 250;
• biopsy - $ 1900;
• positron emission tomography (PET) - a visualization method that determines the exact location of pathology, its distribution, $ 1,650;
• ultrasonic research (ultrasound) - $ 420;
• magnetic tomography (MRI) - 1350 $;
• ezophagogastroduodenoscopy - endoscopic study, whose essence is in a thorough examination of the esophagus, stomach, duodenum with a gastroscope, which is introduced into the patient's stomach through the mouth;
• scintigraphy - the visualization method, the essence of which in the introduction into the patient's body of special radioactive isotopes, which empty radiation and give a two-dimensional image.

In Israel, the patient's diagnosis passes only with the help of the highest quality equipment. Used as traditional methods diagnostics and modern. Such a complex approach Allows the doctors to identify all the nuances of the disease and appoint the most effective treatment In each case.

Recurction of the stomach according to the Billet-1 scheme

Billet-1 operation is the subtotal stomach resection, during which it excised most of A damaged stomach, and between the remaining part of the organ and the duodenum is a special connection-anastomosis "End to the end".

To date, Israel's doctors use Bilrot-1 scheme with a modification of Gaiter II. Bilrod-1 stomach resection is the most common way. surgical treatment, After all, it allows you to save the natural way of food on healthy organs as much as possible.

Advantages of stomach resection according to the Billet-1 scheme:

• The normal connection of the remaining part of the body with a duodenum gives the opportunity to maintain the normal passage of food on the gastrointestinal tract. Compared to an ordinary person, the path of passage in the patient is shortened, but still the duodenal intestine from this path does not turn off. In cases where a significant part of the stomach is left, it can even perform its natural reservoir function.
• In reducing the stomach according to the Billet-1 scheme, the disorder of the intestinal tract (dumping syndrome) arises much less frequently.
• The rapid operation is much easier to transfer the body.
• The Billet-1 operation does not increase the risk of the development of hernia inside the body or occurrence.
• The risk of anastomosis peptic ulcers is eliminated.

Despite all the advantages of the billet-1 operation, it cannot be applied in some cases:

• with a stomach cancer;
• with extensive stomach ulcers;
• with coarse stomach changes.

In such cases, bilot-2 operation is used to resemge the stomach.

Stomach resection according to the Billet-2 scheme

Billet-2 operation is resection of the stomach, during which the remaining part of the organ is sewn with the imposition of anterior or rear gastroenteroanastomosis.

In Israel, Billet-2 is used using various modern modifications that include the closing methodology of the body of the organ, the stuffing from the remaining part of the stomach of the cushion, etc.

Recreation of the stomach according to the Billet-2 scheme is performed with stomach ulcers, stomach cancer and other diseases in which the use of bilrot-1 operation is contraindicated. In such cases, the organ resection is carried out in the volume that is determined by the disease and the stomach condition. In the future, the remaining part of the stomach is sewn in a special way to a thickest intestine.

Despite the fact that the bilrote-2 operations occurs more often by dumping syndrome, in some diagnoses it is the only way to make the gastrointestinal tract.

Advantages of Billet-2 stomach resection in Israel:

• there is an extensive resection of the stomach without the need to tension the gastroinnye seams;
• in cases where the patient has a duodenal ulcer, the occurrence after resection on the bitroid-2 peptic ulcers anastomosis is less likely;
• in cases where a patient has a duodenal ulcer with rude pathological defects of the duodenum, the stroke of the cult is much easier than the anastomosis with the stomach;
• in the presence of a patient a non-speaking duodenal ulcers to restore the permeability digestive system It is possible only with resection on bilrhot 2.

The disadvantages of the operation according to the Billet-2 scheme are the following factors:

1. increases the risk of development in the patient dumping syndrome;
2. the complexity of the operation;
3. the occurrence of a leading loop syndrome;
4. the appearance of inner hernia is possible.

The difference between Bilrothe 1 and Bilrothe 2 lies not only in the method of sewing the culture of the organ, but also in the degree of expression of dumping syndrome and the subsequent work of the gastrointestinal tract. In Israel, bilrhot 1 and 2 operations are performed by the best surgeons that have extensive experience in the successful stomach resection.

In the clinics of Israel, with such resection of the stomach, a special intraoperative express analysis of the remote part of the stomach is carried out. This allows you to adjust the decision on the volume of surgical intervention right on the spot.

Thanks to this, the doctors of Israel can be confident that they removed the entire pathological area. Express analysis also allows you to remove nearby affected lymph nodes if necessary. This approach makes even more efficient and reduces the manifestation of dumping syndrome and other side Effects after operation.

The cost of resection of the stomach in Israel

In Israel, a personalized approach to the treatment of each patient is applied. This means that all diagnostic and treatment schemes are selected individually depending on the disease, the patient's well-being, disease flow and so on.

That is why the cost of bilrhot operations is calculated individually for each. In order to employees medical center Free calculated the cost of the operation specifically in your case, fill out the form feedbackWhen attaching all the tests you have.

In order to obtain detailed information on bilrhost operations in Israel, fill out the application or contact us at the specified phone numbers, and in order to get an individual estimate and clarify the prices of stomach resection in Israel, fill out the form "Calculation of treatment cost". Within 24 hours, IZMEDIC managers are guaranteed to provide you with all the necessary information.