International Medical Journal, Vol. 21., Iss. 1, 2015, P. 32−34.
A METHOD OF AREFLUX ISOPERISTALTIC CHOLEDOCHOJEJUNODOUDENOSTOMY
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Mechanical jaundice is a syndrome developing as a result of a number of benign and malignant diseases of hepatopancreatoduodenal area causing bile out−flow disorders and characterized by cholemia and acholia. Correction of bile out−flow disorders under inefficacy of mini−invasive transpapillary interventions is carried out with the help of renewing and reconstructive interventions. In spite of some success in mechanical jaundice syndrome treatment it should be recognized that many important problems of surgery have not been solved yet. Thus, elaboration of new, more physiological ways of surgical treatment of patients with common bile duct impassability of non−neoplastic origin is necessary. The aim of our work was elaboration of biliodigestive anastomosis allowing preserving morphofunctional state of the duodenum and providing prevention of ascending reflux−cholangitis. Open bile flow correction according to the original method was done as the second stage of treatment in 5 patients with distal broaching stricture of common bile duct as well as under its glandular stenosis against a background of pseudotumor−like pancreatitis. After 180° laparotomic rotation of the initial area of jejunum and its carrying into the window of mesocolon, standard formation of choledochojejunoanastomosis according to A.A. Shalimov with plug on leading intestine and choledochojejunoanastomosis with Braun fistula were done. Besides lower the choledochjejunoanastomosis, in isoperistaltic direction, side−to−side jejunoduodenoanastomosis was formed with more distal plug on the discharging intestine. The necessary requirement to the anastomosis is absence of duodenal impassibility signs. The suggested isoperistaltic biliodigestive choledochojejunoanastomosis provides complete bile entrance into the duodenal lumen with its morphofunctional renewal preventing hemorrhagic complications; preserving anatomic nervous and vascular interconnections allowing preserving the motor activity of small intestine loop used for bile passage. The isoperistalsis principle of the used area of small intestine provides prevention of ascending reflux−cholangitis development.
Key words: mechanical jaundice, acholia, reflux cholangitis, biliodigestive anastomosis.