FIELD: medicine, surgical gastroenterology.
SUBSTANCE: at no destruction of major and minor duodenal papillae they should be isolated out of cicatricial-ulcerous focus, the edges of posterior wall of duodenal distal end should be sutured along the circumference of major duodenal papilla and further till the removal of diastasis with duodenal proximal end. One should implant minor duodenal papilla into posterior wall of duodenal anastomosis, longitudinally dissect anterior wall of duodenal distal stump at length that corresponds to lumen's reconstruction, form anterior-lateral walls of anastomosis with shifted fragments of mobilized distal duodenal department. In case of destruction of major and minor duodenal papillae out of cicatricial-ulcerous focus one should isolate terminal departments of Wirsung's, Santorini's and common bile ducts. One should suture the edges of posterior wall of duodenal distal department along the circumference of Wirsung's and common bile ducts and further till the removal of diastasis with duodenal proximal end. One should implant Santorini's duct into posterior wall of duodenal anastomosis, longitudinally dissect anterior wall of duodenal distal stump at length that corresponds to lumen's reconstruction, form anterior-lateral wall of anastomosis with shifted fragments of mobilized distal duodenal end. The innovation enables to radically heal the complicated ulcer, reconstruct anatomical structure of duodenum, major and minor duodenal papillae, improve functional results of interference, prevent the development of pancreonecrosis and failure of sutures in post-surgical period.
EFFECT: higher efficiency of therapy.
6 dwg, 1 ex
