Patent RU-2532383-C1 (RU)
Inventor: KHORON KO JURIJ VLADILENOVICH
IPC: A61B17/00
Filed: 2013-11-06
Granted: 2014-11-10
Abstract: FIELD: medicine. 
     SUBSTANCE: invention refers to medicine, namely to surgery, and can be used for surgical treatment of corrosive strictures of a terminal portion of the common bile duct. Surgical organs are approached. The parietal peritoneum is dissected along an upper portion of the duodenum and an initial portion of its descending portion. The duodenal bulb is mobilised and turned downwards. The retroduodenal portion of the common bile duct is exposed. Then, 4-6 transverse adventitious muscular sutures are applied on a posterior wall of the duodenum at 2 cm in the cranial direction and at 2 cm in the caudal direction from the estimated duodenotomic opening. The common bile duct is dissected in the retroduodenal portion longitudinally by 13-15 mm. The common bile duct opening is created. The posterior wall of the duodenum is dissected transversally by 13-15 mm in a projection of the common bile duct opening. The common bile duct opening is created. Edges of the common bile duct and duodenotomic openings are taken by two traction sutures and diverged. Lower and upper semipurse-string retention sutures are respectively applied on the borders of the lower and upper semi-circles of the duodenotomic opening. The sutures are applied so that to leave a distance of not less than 5 mm between the pricks in and out of the ligatures of the upper and lower semipurse-string retention sutures. When applying the lower semipurse-string retention suture, the needle is pricked in from the duodenum. The needle is delivered through all the layers of the duodenum. The needle is pricked in from the adventitia and further, and pricked out from the duodenal mucosa with covering all the layers through. The upper semipurse-string retention suture is performed by applying the adventitious muscular sutures not penetrating into the duodenal lumen. A lower lip of the anastomosis is formed. Then 4-5 separate interrupted sutures are applied on the edges of the lower semi-circles of the common bile duct and duodenotomic openings through all the layers of the duodenum and common bile duct to connect the walls of the common bile duct and the duodenum by the traction sutures. The lower semipurse-string retention suture is tightened up and tied. An upper lip of the anastomosis is formed. Then 4-5 separate interrupted sutures are applied on the edges of the upper semi-circles of the common bile duct and duodenotomic openings through all the layers of the duodenum and common bile duct to connect the walls of the common bile duct and the duodenum by the traction sutures. The traction sutures are removed. The semipurse-string retention suture is tightened up and tied, thereby forming an antireflux choledochoduodenoanastomosis. The incision wound is closed in layers. 
     EFFECT: method provides more effective surgical management of the corrosive strictures of the terminal portion of the common bile duct, prevents duodenal reflux into the common bile duct and cholangitis progression by creating the antireflux choledochoduodenoanastomosis. 
     4 dwg, 2 ex