ОТКРЫТАЯ ЭЗОФАГОГАСТРАЛЬНАЯ ДЕВАСКУЛЯРИЗАЦИЯ В СОБСТВЕННОЙ МОДИФИКАЦИИ. ПРЕДВАРИТЕЛЬНОЕ СООБЩЕНИЕ О СЕРИИ СЛУЧАЕВ

Abstract

Introduction. Progress in surgical technologies and the presence of a category of patients with alcoholic cirrhosis of the liver and bleeding from esophageal varices who can not take nonselective beta-blockers and undergo repeated sessions of endoscopic ligation, allow to perform open esophagogastric devascularization as a reserve technique in surgical practice. Aim. Preliminary analysis of the results of performing open esophagogastric devascularization in its own modification. Material and methods. Open esophagogastric devascularization in its own modification was performed in five patients with Child-Pugh class B cirrhosis (3 men and 2 women) aged 44 to 59 years for delayed and planned indications after a repeated episode of bleeding from esophageal varices (from 2 up to 4 relapses). The technique included open esophagogastric devascularization with esophageal transection in combination with truncal vagotomy and pyloroplasty without splenectomy. Results. All patients underwent successful surgery. The duration of the operation (Me [min; max]) was 245 [230; 310] min. The time spent in the department of anesthesiology, resuscitation and intensive care was 2 [1; 5] days. During the postoperative follow-up of these patients for the period from 31 to 92 months, there were no recurrences of bleeding from esophageal varices. In all patients, endoscopic examination after a year showed regression of the degree of expansion of esophageal varices. Сonclusions. The use of the described methodology of multilevel stitching of submucosal esophageal varices in addition to hardware transection during open esophagogastric devascularization in its own modification enable to detect early all remaining significant varicose veins after hardware transsection of the esophagus and carry out their additional stitching without the need to open the esophagus and stomach potentially reduced the incidence of recurrent bleeding.