| Popis: |
The objective of the study was to improve the results of surgical treatment of patients with complicated peptic ulcer disease by improving the method of performing selective proximal vagotomy. Materials and methods. According to the proposed method, 44 patients were operated on. All patients underwent duodenoplasty in combination with selective proximal vagotomy. Results. The main causes of intraoperative damage to the splenic vessels and pancreas were the transsection of the gastro-splenic and gastro-diaphragmatic ligaments without their preliminary separation from the underlying anatomical formations, as well as the presence of pathological scar-inflammatory changes in this area. The proposed method of selective proximal vagotomy (patent No. 2717209 dated 03/18/2020) includes isolation of the upper edge of the esophageal hiatus, mobilization of the stomach floor and skeletonization of the left diaphragmatic peduncle transsection of the ascending gastric artery, dissection of the small curvature of the stomach and the cardia in the direction from the angle of the stomach to the cardia with the transsection of transverse neurovascular gastric branches, denervation of the abdominal part of the esophagus, isolation of the right diaphragmatic peduncle and the posterior trunk of the vagus, closure of the exposed muscles of the small curvature of the stomach with serous-muscle sutures up to the cardia, suturing of the esophagus, cardia and the bottom of the stomach by lateral invagination. Conclusion. The proposed method of selective proximal vagotomy allows to completely exclude intraoperative trauma of the pancreas, spleen and its vessels, as well as to exclude postoperative discoordinated disorders of gastric motility. The advantages of the proposed method also include a significant reduction in the complexity of the operation, simplification of the execution technique and reduction of the operation time. The method can be performed by surgeons without experience in SPV operations. |
