Authors
Dryazhenkov G.I.1, Dryazhenkov I.G.2, Babak P.P.1, Los I.P3
1 Yaroslavl regional clinical hospital, Yaroslavl
2 Yaroslavl state medical University, Yaroslavl
3 Clinical hospital № 9, Yaroslavl
Abstract
Pancreatogastroanastomosis in pancreatoduodenal resections was used in 31 patients. The stump of the pancreas was sutured with lost drainage and invaginated into the lumen of the stomach by 10–12 mm through the back wall. A circular single-row seromuscular suture of the stomach with the tissue of the left gland was used. The stump of the antral part of the stomach and the common hepatic duct were separately sewn terminolateral into a single isolated jejunum with the use of drainage through the oral end of the suspended enterostome to unload the anastomoses in the first days and possible enteral nutrition in the future. With this method of pancreatoduodenal resection, it is possible to simultaneously endoscopic study of pancreatogastro-, gastroentero- and hepaticoejunoanastomosis. Endoscopic examination of pancreatogastroanastomoses was performed in 27 patients from 2 weeks to 12 years. Attention was paid to the function of the mouth and the timing of its epithelization when the invaginated stump of the parenchymal organ was sewn into the stomach wall. The total area of the invaginate was 500–600 mm2. By the end of the first month, the stump of the gland was covered with massive, dirty-colored granulations and unassociated ligatures, and single, small granulations with epithelization were visible along its periphery. In the next 2–4 months, there was a circular "influx" of young gastric mucosa from the periphery to the center of the stump of the gland. The new mucosa filled in all the defects and depressions of the anastomosis zone, leveling the plane of the "iron-stomach" site. The mouth of the duct Wirsung viewed slit-like or round shape with a diameter of 1–2 mm. By 6 months ended epithelialization of the anastomosis zone. In the following months and years, the mucosa in the area of the mouth was atrophic, motionless, with no inflammation.
Keywords: pancreatoduodenal resection, endoscopy of pancreatogastroanastomosis.
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