POUCH JEJUNOGASTROPLASTY AS AN METHOD RECONSTRUCTION AFTER GASTRECTOMY

Objective: to evaluate surgical safety and functional effectiveness of pouch jejunogastroplastic as a physiological method of reconstruction of the upper digestive tract after gastrectomy.

Methods: in the period 2013-18, at the Scientific and Research Center for Surgery named after A.V. Vishnevsky 30 patients after gatrectomy was performed a jejunogastroplastic reservoir (jejunal pouch) in the original technique. Of these, 25 (83.3%) patients were operated due to stomach cancer, and 5 (16.7%) due to operated stomach disease. Average age of patients was 54 years, male-20 (66.7%), female-10 (33.3%). After the resection stage of jejunal segment, 40 cm length resection of 3rd or 4th pairs of mesenteric arteries was done. Further it was mobilised into the upper section the abdominal cavity through the window into the mesocolon, restored the cavity of small intestine by an end-to-end anastomosis. The intestinal segment was divided in half by incomplete dissection of mesentery till the main supply vessel and from two split segments formed an isoperistaltic reservoir, joining them with each other as “side to side” for 10 cm in a single-row twisted seam. The reconctruction was completed by the formation of double-row duodenal-jejunal anastomosis and single-row esophagojejunal anastomosis.

Results: surgical complications in early postoperative period occurred in 2 (6.6%) patients: one had partial esophagojejunal anastomosis leak, the other had subphrenic hematoma. Fatalities during the period of hospitalization was not observed. At the end of the study under observation 23 (76.6%) of 30 patients remained. Long-term examination of patients revealed in 13 (56.6%) good, 7 (30.4%) - a satisfactory result.

Conclusion: the obtained results of the performed operations prove the viability of jejunogastroplastic reservoir (jejunal pouch) as a physiological method for the restoration of upper digestive tract after gastrectomy. Able to partially replace the loss of gastric function, creating conditions for the compensation of the digestive system bringing activity closer to the physiological norms.

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