Summary

doi: 10.25005/2074-0581-2016-18-2-13-17
EFFICIENCY OF RECONSTRUCTIVE OPERATIONS IN DEHISCENCE OF ANASTOMOTIC SUTURES OF STOMACH AND DUODENUM

V.I. Belokonev, I.V. Kharin

Chair of surgical diseases №2 SBEI of HPE «Samara State Medical University», Samara, Russian Federation

The paper presents the results of treatment 73 patients with dehiscence of sutures that developed after surgery of complicated peptic ulcer disease. In dehiscence of suture after ulcer suturingthe choice of surgery was considered resection of the stomach, and in insolvency of gastroduodenalanastomosis - reconstructive gastric resection by Billroth-II in modification by Balfour or Roux. Suturing was performed in a small diameter of the defect and in most severe patients with unstable hemodynamics.

In suturing of insolvency linefrom 17 patients died 11 (65%), at gastroduodenal stoma from 13 - 10 (77%), in gastric resection from 16 - 12 (75%), in resection by Billroth-II from 25 - 12 (48%). The main cause of death in patients who underwent gastric resection by Billroth-II was the failure of the stump of the duodenum. This complication occurred in 1/3 of patients with fully suturing of duodenal stump. From 30 patients 13 died (43%) operatedin a reaction stage peritonitis, 25 (71%) from 35 – in stage of enteric insufficiency, 7 (88%) from 8 – in stage of bacterial shock and poly organic insufficiency.

Analysis of the results showed that gastric resection and re-resection gives the best results in the reactive stage of peritonitis, radical surgery in bacterial shock stage and POI is unpromising. To prevent nsolvency of «difficult» duodenal stump in gastric re-resection by Billroth-II instage of peritonitis duodenostomy is indicated.

Keywords: dehiscence of sutures, gastric resection , gastric re-resection.

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