[Prevention of reflux-esophagitis after gastrectomy].

It is presented the results of gastrectomy in 431 patients with varying reconstructive-reparative stage. Patients were divided into two comparable groups. The main group consisted of 146 patients who underwent developed technique with food reservoir performing after gastrectomy. Control group included 285 patients after conventional digestive tract reconstruction. It was concluded that 30.4% of patients have entero-esophageal reflux, in 21.7% and 8.7% of patients endoscopic and morphological signs of reflux-esophagitis were observed respectively. Suggested technique creates gas bubble providing obturator mechanism and decreasing the frequency of entero-esophageal reflux to 26.3% and reflux-esophagitis to 5.3%. It proves advantage of suggested method of gastroplasty for prevention of reflux-esophagitis in comparison with traditional digestive tract reconstruction after gastrectomy.

[Spleen-preserving D2 lymphodissection in gastrectomy]. / Splenosokhrannaya limfodissektsiya D2 pri gastrektomii.

AIM: To analyze immediate and remote results of surgical treatment of 480 patients with gastric cancer who underwent total gastrectomy. MATERIAL AND METHODS: The study group included 371 patients who had spleen-preserving D2 lymphodissection during gastrectomy and control group consisted of 109 patients after D2 lymphodissection with splenectomy. Duration of surgery was 183.7±33.8 and 184.1±30.9 min in study and control groups respectively (p=0.72), blood loss - 330.2±33.7 and 351.8±28.8 ml (p=0.0001), incidence of postoperative complications - 6.7% (25 cases) and 4.6% (5 cases) respectively (p=0.5), mortality rate - 2.7% and 0.9% respectively (p=0.46). Number of excised regional lymph nodes of groups 10 and 11 was in most patients of the study group - 5.8 and 5.5 (p=0.92). Metastases in splenic hilus lymph nodes were diagnosed in 28 (7.5%) and 9 (8.2%) patients of the study and control groups respectively (p=0.30), metastases in lymph nodes along splenic vessels - in 24 (6.5%) and 7 (6.4%) patients respectively (p=0.90). RESULTS: 5-year survival in the study group was 40.3±3.0%, average life expectancy - 3.4±3.3 years, in the control groups - 33.1±5.6% and 2.7±2.5 years respectively. It was concluded that spleen-preserving D2 lymphodissection decreases incidence of postoperative complications and has similar drastic nature as standard lymphodissection with splenectomy.

[Reconstruction after the gastrectomy by proximal stomach cancer].

The 30 years experience of surgical treatment of the proximal gastric cancer type II and III by Siewert classification in 681 patients was analyzed. 448 gastrectomies and 233 gastrectomies with proximal esophagus resection were performed. Gastrectomy with esophagus resection led to more complications (34.8±3.1%; p<0.001) and lethal out±comes (21.5±2.7%), then standart gastrectomy (16.5±1.8% and 7.6±1.3%). The dehiscence of the esophagointestinal anastomosis was registered in 5.6±1.6% after the gastrectomy with esophagus resection and in 0.2±0.2% after the transperitoneal gastrectomy (p<0.001). The loop method by Schlattler proved to be the optimal reconstructive technique. The Roux-en-Y anastomosis was preferable by the insufficient length of the mesentery. The risk factors of the esophagointestinal anastomosis insufficiency were: cancer stage (p<0.001), local invasion of the neighbouring organs (p<0.05), combined surgery and esophagus invasion (p<0.001), male gender (p<0.001) and lack of the surgical skills for gastrectomy (p<0.02).

[The ways to reduce the occurrence rate and severity of alimentary-enterogenic autonomic syndrome after gastrectomy].

The efficacy of a new gastroplasty method, concerning prophylaxis of occurrence and reduction of severity of alimentary-enterogenic vegetative syndrome (AEVS), was studied in 189 patients, suffering gastric cancer, in whom gastrectomy was performed. In the patients of the main group while conducting of restoration stage of the operation the reservoir for food in initial jejunal portion was formatted, in a control group a standard loop-like reconstruction was applied. In the remote follow-up period of observation while a new gastroplasty method was applied there the reduction of rates of hypoglycemic and hyperglycemic syndromes was registered. In the control group a severe form of AEVS was diagnosed in 1 year--in 2.5% of the patients, in 2 years--in 3.9%, in the main group this complication was not observed.

[Postoperative pancreonecrosis prophylaxis in a gastric cancer surgery].

Efficacy of a new method of intraoperative regional sympathetic blockade of splanchnic nerves was estimated, basing on the results of surgical treatment of 3134 patients, suffering gastric cancer. While comparing the immediate results of surgical interventions there was established, that the risk of postoperative pancreatitis occurrence (lethality) is dependent on the kind of operation performed and its traumaticity. The risk of postoperative pancreonecrosis occurrence (lethality) lowering after standard surgical and combined intervention, after gastric surgery with pancreatic resection was promoted by application of a spiritus-novocaine blockade with the objective to suppress sympathetic reflexes as an element of anesthesia intraoperatively and in early postoperative period.

[Gastrectomy with the intestinal reservoir formation as a method of prophylaxis of the main postgastrectomy complications].

In oncological clinic there was elaborated and introduced into the practice a new technology of a gut reconstruction in patients with gastric cancer while gastrectomy performance, which include the intestinal reservoir formation using first part of jejunum. Technology of the intestinal reservoir formation is not a complex one, the operative intervention time, in comparison to that in a standard loop reconstruction while gastrectomy performance, increases by (33.2 +/- 3.4) min, the blood loss volume constitutes (370.7 +/- 133.2) ml. Complications, occurring after intestinal reservoir formation, were not observed. Damping--syndrome of a mild degree have occurred in 4 (5.9%) patients. The gas bladder restoration have had secured a closure mechanism of the oesophagointestinal junction zone restoration, thus eliminating a reflux-oesophagitis occurrence. Suturing of the abducting flexure of a two-barrel jejunal loop eliminates the abducting intestinal loop syndrome occurrence. The quality of life index in 12 months postoperatively had constituted (82.9 +/- 2.2) points.

[Simultaneous surgeries in cancer surgery]. / Simul'tannye operatsii v onkokhirurgii.

Of 14,448 operated patients with malignant tumor of different localization in 368 (25% +/- 0.1%)--simultant operations (SO) were performed. Terminology of SO was determined in oncosurgery, classification of indications to performance of SO was proposed in patients with coexistent oncosurgical diseases. Early postoperative complications had occurred in 63 (17.1% +/- 1.9%) patients, 20 (5.4% +/- 1.2%) patients died. Social-economical expediency of SO performance in oncosurgery was substantiated.