METHOD OF AREFLUX ESOPHAGOGASTRIC ANASTOMOSIS FOR STOMACH CANCER TREATMENT Russian patent published in 2009 - IPC A61B17/11 

FIELD: medicine; surgery.

SUBSTANCE: midline laparotomy is applied. Abdominal esophageal part is mobilised. Stomach is resected proximally. Cuff is made of muscular submucous duplication. Esophagogastric anastomosis is formed by double layer suturing. Muscular layer of esophagus in abdominal part is dissected circularly to submucous layer and turned upwards. Upper end of esophagus is fixed with separate stitches providing muscular sphincter. Mucosubmucous layer is dissected from stomach. Posterior lip of anastomosis is formed. The first stitching row is applied thus sewing posterior esophageal semicircles and gastric stump with 3-4 interrupted sutures. On esophagus the suture captures muscular coat 0.5 cm above the formed cuff. On stomach the suture captures seromuscular coat of anterior wall. Distanced 1 cm from stitch edge on anterior wall of stomach, seromuscular layer is dissected by esophagus width thus forming anastomosis. The second stitching row follows. Mucosubmucous esophageal layer is delivered upwards. On stomach the suture captures muscular duplication of inferior posterior part of formed cuff. On stomach the suture captures seromuscular layer by edge of dissected wall within top angle of anastomosis. Uninterrupted absorbable suturing follows thus forming posterior wall to lower angle of anastomosis. Mucosubmucous layer is dissected within anastomosis on anterior stomach wall. Wound edges are pulled apart. Free mucosubmucous esophageal membrane is immersed whereat prefixed with absorbable suturing through formed aperture in stomach lumen. Anterior lip of anastomosis is formed by continuing esophagogastric uninterrupted suturing originated from lower angle and directed to the top. Herewith on esophagus the suture captures lower edge of anterior part of cuff, while on stomach the suture captures seromuscular layer on anastomosis edge. Anterior esophageal semicircle and stomach stump are sutured with 3-4 central stitches thus forming the second stitching row. On esophagus the suture captures muscular coat 0.5 cm above the form cuff. On stomach the suture captures seromuscular layer of anterior wall, distanced 2-3 cm from the first stitching row.

EFFECT: prevention of anastomosis inefficiency, esophagitis, infection of anastomosis zone with mouth contents.

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