[Method for gastric resection with end-to-end gastroduodenal anastomosis]

The authors suggest a method of stomach resection in which the gastroduodenal anastomosis is created by applying sutures to the layers after separating the sheaths of the organs into layers. The inner sheaths (muco-submucous) of the organs are butt joined after their excision almost at the base, while the outer sheaths (seromuscular) are sutured with rarely placed crimping sutures. The rare placing of the sutures and moderately tight tying of the ligatures prevent impairment of tissue nutrition, whereas crimping of the outer sheath provides wide contact of the serosa. Narrowing of the anastomosis does not occur because the inner sheath is sutured in a butt manner while the ridge formed on the outer sheath is outside the lumen. The wound of the anastomosis heals by first intention. The method was used in 251 patients with various diseases of the stomach and duodenum. Their ages ranged from 13 to 73 years. Most were seriously ill. Two patients died, one from the fibrinolysis syndrome, associated with massive transfusion of blood, and hepatorenal failure, the other died from pancreonecrosis. The sutures of the anastomosis were efficient in both cases. Incompetence of the anastomosis sutures was encountered in one patient. Incompetence of sutures of the closed part of the gastric stump was diagnosed in another patient. Perforation of acute ulcer of the gastric stump occurred in still another patient. All of these patients as well as the other patients recovered.