The method of the isolated reconstruction by gastropancreatoduodenal resection

The modification of the reconstructive stage of gastropancreatoduodenal resection aims to increase the security of the pancreatojejunoanastomosis by minimizing the impact of such aggressive substances as bile and pancreatic juice. The modification represents the isolated pancreatojejunoanastomosis on the Roux-en-Y intestinal loop and gastro- and hepaticojejunoanastomoses on the second intestinal loop, separated with the use of the stub. Thus, the method allows the separate passage of pancreatic juice, bile and gastric contents, excluding their impact on other anastomoses. The described modification was performed in 6 patients. There were no cases of the anastomotic insufficiency. The mean hospital stay was 10,5 days. Thus. The method proved to be effective and safe, providing good initial results.     

Extended gastropancreatoduodenal resection (GPDR)

The authors for the first time in Russia have begun serial performance of the extended GPDR. The operations were accompanied by careful morphological investigations of the removed organs and tissues. It was established that in all patients with exocrine cancer of head of the pancreas the tumor growth extended the region of the regional lymph nodes, i.e. standard GPDR in these patients oncologically could not be considered as adequate operation. Further performance of GPDR for pancreatic head exocrine cancer will expand knowledge about metastatic spread and will open opportunities to improve long-term survival of the patients with exocrine cancer of the head of the pancreas.     

Method of formation of terminolateral pancreatojejunal anastomosis in gastropancreatoduodenal resection

The author describes his method of the formation of pancreatojejunal anastomosis in gastropancreatoduodenal resection, which allows reducing the risk of the development of postoperative pancreatitis and incompetent amastomosis. This method was used in 5 patients with tumors of the pancreas head, major duodenal papilla, and duodenum. The patients had no complications in the postoperative period. The method of the formation of terminolateral pancreatojejunal anastomosis including drainage of the pancreatic duct with microdrainage, fixed in the area of anastomosis, and closure of the opening in the intestine with a simultaneous suturing of the intestine wall to the pancreas by the S-shaped semi-purse-string suture with an atraumatic filaments should be preferably used for the loose tissue of the pancreas and its narrow (not more than 3 mm) duct.     

A method of pancreatojejunostomy in pancreatoduodenal resection]

The article deals with 6 pancreatoduodenal resections with establishment of pancreatojejuno-anastomosis, invagination of the pancreatic stump, and formation of an antireflux apparatus in the intestinal lumen. In none of the cases, pancreonecrosis of the stump and incompetence of the pancreatojejunoanastomosis were encountered after formation of the anastomosis by this method. The late-term results were studied in 4 patients. Complications linked with pancreatitis of the stump were not recorded during a follow-up period of 4-6 months.     

A new method of reconstruction for chest wall resection

Sixteen patients who involved in chest wall disease underwent major chest wall resection between April 1995 and January 1999. The underlying diseases were 6 recurrence of breast cancers, 4 direct invasion by primary lung cancer, 2 metastatic chest wall tumor, one direct invasion by metastatic lung tumor, one direct invasion by metastatic mediastinal tumor, one radio-induced-necrosis of the chest wall, and one chest wall infection. In 9 patients, the thoracic cage reconstruction was performed using double sheets of absorbable mesh (Dexon mesh), cross string sutures and autologous ribs grafts. None of the patients had major respiratory failure and chest wall unstability. No late complications including infections, pains, recurrence and others related to reconstruction materials have been observed.     

A method of pancreato-duodenal resection and total duodeno- pancreatectomy

During 1975-88 the staff of the Vishnevski?+ Institute of Surgery performed 95 pancreatoduodenal resections (PDR) and 23 total duodenopancreatectomies (TDPE) in malignant tumors of the head of the pancreas (49), major duodenal papilla (30), terminal choledochus (12), duodenum (12), and in 15 patients with chronic pancreatitis. In 13 cases PDR and TDPE were undertaken as a second operation after creation of biliodigestive anastomoses: after laparoscopic cholecystostomy in 24 and after various abdominal operations in 20 cases. In 30 cases PDR was carried out with the formation of a pancreaticojejunal+ anastomosis, by the longitudinal techniques in 7 of them, in 47 cases with occlusion of the pancreatic duct, and in 6 with the formation of a "occlusive" pancreaticojejunal anastomosis++ suggested by the authors. PDR was performed in 3 cases with maintenance of the stomach and in 4 in combination with vagotomy. The mortality rate was 20% after PDR and 39.1% after TDPE.     

A simple method for predicting pulmonary function after lung resection

A simple method for preoperative prediction of lung function following pulmonary resection is described. The principle of the method is assessment of the ventilated part of the lung which possibly will have to be resected. It is based on careful evaluation of the bronchoscopic and radiologic studies always performed in this category of patients. The accuracy of the predicted postoperative change in FEV1 sec and VC is comparable to results obtained from standard radioisotope split lung function tests. The lung function seemed to improve between 1 and 6 months postoperatively.     

A method for the resection of cranial tumours and skull reconstruction

A new technique for the resection of cranial tumours and subsequent reconstruction using stereolithographic (SL) biomodelling and customized cranioplastic implants has been developed. The technique is based on a custom model of the tumour and surrounding skull from which the resection of the tumour and shape of the cranioplasty can be determined. A patient with a hyperostotic fronto-orbital meningioma was selected. CT was performed and SL biomodels manufactured. The surgeon marked the resection margin on the biomodel and a customized resection template was fashioned. The tumour was then resected from the biomodel and a customized acrylic implant was manufactured to reconstruct the defect. At surgery the tumour was exposed in a routine fashion and the template used to mark the resection margin. Once resected, the defect was reconstructed with the custom cranioplastic implant. The technique facilitated accurate surgical resection of the tumour and subsequent reconstruction. The surgeon reported several advantages of the technique including increased confidence, reduced operating time (at least 1 h), excellent cosmetic results, accuracy, and simplicity. The patient reported that the opportunity to see the biomodel, template and implant improved her understanding of the procedure.