TECHNIQUE ON THE STOMACH DURING PANCREATICO-DUODENECTOMY

Abstract

Summary. Objective. To develop an algorithm for the differential choice of resection or pylorus-preserving techniques on the stomach with the choice of the reconstructive stage and determination of the location of the gastroenteroanastomosis (GEA). Materials and methods. The paper presents an analysis of the treatment of 302 patients with obstructive diseases of the pancreaticoduodenal zone who underwent pancreaticoduodenectomy (PDЕ). The following surgical procedures were performed on the stomach: resection of ½ of the stomach, antrumectomy (hemianthrumectomy) in combination with vagotomy (or without vagotomy), pylorus-preserving PDE. The gastroenteroanastomosis (GEA) (or duodenojejunoanastomosis) was located anteriorly and posteriorly. The severity of postoperative gastrostasis was assessed according to the ISGPS classification, 2007. Results and discussion. Resection of ½ of the stomach was performed in 88 (59.9%) patients in the main group and in 98 (64.1%) in the comparison group, antrumectomy (hemianthrumectomy) without vagotomy – in 42 (28, 6 %) and 22 (14.4 %), respectively, antrumectomy with vagotomy – in 8 (5.4 %) and 32 (20.9 %), respectively, pylorus-preserving PDЕ – in 9 (6.1 %) and 1 (0.7 %), respectively. Pre-operative GEA was used in 110 (74.8%) patients in the main group and 52 (34.0%) in the comparison group, post-operative GEA – in 37 (25.2%) and 101 (66.0%) patients, respectively. Postoperative gastrostasis developed in 18 patients: 7 (38.9%) in the main group and 11 (61.1%) in the comparison group. Conclusions. Among the techniques used in the stomach for PDE, organ-preserving and organ-sparing techniques with predominantly anteroseptal location of the GEA or duodenoenteroanastomosis are preferred.