Причины несостоятельности швов анастомозов после гастрэктомии

Summary. Objective: to study the causes and methods of prevention of  leakage of  the anastomosis after gastrectomy. Materials and methods. Technical causes of leakage of the  anastomosis are well known: tension fabrics [8,  9, 14, 15], bad adaptation of a sewed surfaces [8, 9], the first brackets after extraction, suturing devices [12,15], the inept application of suturing devices and improper care of them [15,16], circulatory disorders on the level of crosslinking of the segments of the digestive tract [1, 8, 9,  16], suturing during primary longitudinal muscle layer of the esophagus [16], which leads to the eruption of the seams trauma to the pancreas, as a result, there is an outflow of aggressive contents from the damaged or resected pancreas [9], which leads to infection of the anastomosis suture line [8, 12], as well as necrotic and inflammatory processes [17], suturing the affected area of the esophageal wall, also often leads to failure of esophageal-intestinal anastomosis [12, 14]. Numerous studies have shown that one of the main causes of leakage of the esophago-intestinal anastomosis is lymphnodedissection in a volume of  D2. Lymphnodedissection in the volume of D2 compared with D1 was accompanied by a significant increase in postoperative mortality (10-13 and 4-6, 5%), the frequency of postoperative complications (43-46 and 25-28%), especially the especially the leakage of anastomosis (in the English study, it reached 26% in the group D2) and abdominal abscesses, the frequency of repeated operations (18 and 8%), the average length of stay of patients in the clinic after surgery (23-25 and 18 days); all differences are statistically significant (<0.05—0.05). 0.001). Based on these data the authors concluded that the increase in volume of lymph node dissection leads to significant increase in the number of postoperative complications and lethality, because to obtain data on long-term results of resection of D2 is not should be used in the treatment of gastric cancer, at least in Europe. [3,4,5] Results and their discussion. During the period from 1986 to 2005, in Republican oncological center  performed 1477 gastrectomy by Bondar G. V. despite the high reliability of the anastomosis, esophageal-intestinal anastomosis leakage was observed in  16 of our patients (1.08±0.27%), and in 2 (0.14±0.1%) leakage of duodenal stump, operated in this period of time. Conclusions: the use of mufti esophageal-intestinal anastomosis, formed by the method of  Bondar G. V. meets the modern requirements of surgery of gastric cancer, anastomosis reliable and provides good conditions for digestion in the new conditions after the gastrectomy, which corresponds to the literature.