COMBINED OPEREATIONS FOR CALCULOUS CHOLECYSTITIS AND CHRONIC PANCREATITIS AGAINST THE BACKGROUND OF ARTERIOMESENTERIAL DUODENAL COMPRESSION
Aim. To improve the diagnosis of arteriomesenterial duodenal compression (AMDC), to develop combined operations for calculous cholecystitis and chronic pancreatitis in patients with chronic disturbance of duodenal permeability. Materials and methods. The results of examination and operative treatment of 99 patients with biliary and pancreatic diseases against the background of AMDC are presented in the paper. Roengenological method was used to diagnose AMDC. Duodenal motility was investigated by means of the method of open catheter using silicon pressure sensor of “Motorola” Firm with original microscheme and graphic image program. Results. 33 patients with calculous cholecystitis underwent cholecystectomy combined with duodenum draining operations; 27 patients were formed Gregory-Smirnov’s duodenojejunoanastomosis. So, the jejunum is crossed in 15–20 cm from its starting point, thus Ru loop is formed and duodenojejunoanastomosis is put to the right from the mesenterial vessels. The rest 6 patients underwent duodenal passage resection with duodenojejunoanastomosis formed in front of mesenterial vessels – Robinson’s operation. The same draining operations were performed in 10 patients with the postcholecystectomy syndrome caused by AMDC. In seven patients choledochoduodenoanastomosis was formed earlier together with cholecystectomy and against the background of AMDC it was displayed by reflux-cholangitis. Early postoperative complications were conditioned by motor-evacuation disturbances. In 3 patients evacuation disturbances after Robinson’s operation were connected with development of anastomosis in the zone of duodenojejunoanastomosis. Hemorrhages in the early period occurred in 3 patients. The results of the follow-up period from 1 to 5 years were studied in 67 operated patients. Conclusion. The choice of the operation in chronic duodenal obstruction caused by AMDC should be individually grounded. The less traumatic duodenum draining operation is Gregory-Smirnov’s anastomosis. It is more preferable by functional results as well.