FIELD: medicine, surgery.
SUBSTANCE: it is necessary to provide operational access to scar-ulcerous focus and horizontal duodenal loop due to mobilizing and shifting right-hand colonic half to the left and upwards, due to mobilizing right-hand half of greater omentum and mesenteric root of small intestine, due to crossing Treitz ligament, due to crossing all ligaments and complete withdrawal of horizontal duodenal loop from under mesenteric root, due to mobilizing vertical duodenal part with pancreatic caput. One should withdraw pancreatoduodenal segment into the wound, perform disinvagination of sutured ulcerous calcar, lance duodenum through the ulcer, widen duodenotomy upwards and downwards by removing tubular stenosis up to the lower horizontal duodenal part, replace its walls towards defect's edges in proximal part by developing a complicated anastomosis due to closing the large defect in proximal part with the walls of the lower horizontal duodenal part by dissecting them along the middle line, if necessary. Anastomosis, duodenojejunal passage and the first jejunal loop should be placed downwards being right-hand against vertebral column. With earlier mobilized omental part one should cover anastomosis and the whole duodenum at the front, as for pancreas it should be covered at the rear. From the top one should apply right-hand department of large intestine, restore ligamentous apparatus of small and large intestines by suturing mesenteric window of small intestine being right-hand against aorta. The method enables to keep nervous-muscular pyloroduodenal bridge and save natural pyloro-papillary diastasis.
EFFECT: higher efficiency of therapy.
12 dwg, 1 ex
