SURGICAL OUTCOMES FOLLOWING NEW TECHNIQUE APPLICATION OF DUODENAL STUMP FORMATION IN GASTRIC CANCER PATIENTS

In 21.6–70.4% cases surgeons meet technical issues while forming duodenal stump when pathological process is closely located. We know about 200 kinds of duodenal stump closure, but with such a great variety of suturing methods there is no guarantee of safe suturing.

Objective. Improve outcomes in patients with pylorus and gastric outlet cancer.

Materials and Methods. Authors worked out a technique for duodenal stump formation (licence no. 2613940, dated 19.01.2016) that was evaluated in 315 patients in 2014–2017. Patients with gastric cancer diagnosis underwent extended (D2-3) gastrectomy 190 (60.5%) and subtotal distal gastric resection according to Balfour 125 (39.5%).

Results. While manipulating with duodenal stump in 45 (57.7%) patients we respected duodenal bulb to ensure radical surgical intervention. In 63 (80.8%) patients to adjust functional surgical results we performed cholecystectomy. Analysing immediate results we observed no suture insufficiency in duodenal stump, in 4 (5.2%) cases we noticed increased levels of alpha-amylase and mild enlargement of pancreas head while performing abdominal ultrasound examination. Postoperative complications were found in 5 (6.4%) cases: thromboembolism of small pulmonary artery branches – 2 (2.6%), lower lobe pneumonia – 3 (6.4%), postoperative pancreatitis – 1 (1.3%).

Conclusion. Application of monofilament for mechanic closure facilitated usage of this technique during laparoscopy with performing extra corporal knots; it secures anatomical, atraumatic adaptation of suturing tissues. This method for duodenal stump hermetic closure is characterised as a simple and reliable technique. Its usage allowed to achieve radical reduction of suture insufficiency and improve total outcomes in gastric cancer patients.

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