The term "pyloroplasty" refers to the type of surgical intervention, during which an expansion of the hole located between the stomach and duodenum is carried out. This is necessary in order to ensure the normal passage of processed food into the small intestine. Currently, there are several techniques for the operation. The best method is pyloroplasty according to Finney.
Indications
During the surgery, the integrity of the digestive tract is not violated. The task of doctors is only to expand the pathologically narrowed area, which occurs due to the influence of various kinds of provoking factors. Pyloroplasty according to Finney is not difficult. In addition, the risk of developing negative consequences is minimal. In this regard, doctors may include surgery in the treatment regimen of a large number of patients.
The main indications for pyloroplasty in Finney:
- Stenosis of the stomach, in particular, the pyloric department. As a rule, this pathology occurs in elderly patients.
- Cicatricial and ulcerative stenosis in young children.
- Ulcer. Finney's pyloroplasty is performed even in the presence of complications in the form of profuse bleeding and perforations.
- Congenital pyloric stenosis in infants.
In addition, the operation is indicated for people who suffer from concomitant diseases, which require vagotomy. This term refers to surgical dissection of the branches of the vagus nerve or its entire trunk, after which the secretion of hydrochloric acid is reduced.
Training
Finney's pyloroplasty is an operation that requires preliminary preparation. First of all, the patient must take blood and urine for analysis, as well as undergo an X-ray examination. Based on the results of the diagnosis, the doctor decides on the feasibility of surgery.
Immediately before the operation, the patient is strictly forbidden to eat and drink water. The duration of the fasting period should be at least 10 hours. A mandatory stage in the preparation is the setting of a cleansing enema. If the patient suffers from nausea and / or vomiting, the stomach is emptied using a special tube.
Technique
The operation is carried out exclusively under general anesthesia. The patient is put into a state of sleep, in which the pain is completely blocked. After that, the operation begins. The technique of pyloroplasty according to Finney is not very difficult for surgeons.
The operation is carried out according to the following algorithm:
- In order to provide access to the pylorus, the doctor makes an incision in the upper abdomen. In recent years, more and more often the operation is carried out using laparoscopic instruments, so that there is no need to cut the front wall of the peritoneum.
- The doctor sutures with a length of 4-6 cm, which along the greater curvature connect the stomach and duodenum. In this case, the gatekeeper should be in the upper part.
- The surgeon opens the lumen of the duodenum and stomach. The cut must be arched.
- In order to stitch the walls of the anastomosis, the doctor puts a continuous suture. It covers all layers of the stomach and duodenum.
- The surgeon's next task is to prevent suture tension. To do this, he conducts the mobilization of the duodenum according to the method of Kocher. The essence of the method is to release the descending part of the organ and then stitching its inner edge with a large curvature of the pyloric stomach.
- The surgeon forms an anastomosis. In other words, it is a combination of tissues.
- After pyloroplasty according to Finney, the doctor restores the integrity of muscle tissue. Brackets or stitches are applied to the skin at the incision site.
The duration of the operation is an average of 1-2 hours.
Recovery period
The patient is constantly monitored for the first few hours after surgery. Nurses regularly monitor blood pressure, body temperature, respiratory rate and heart rate.
In the first 1-2 days, nutrient solutions are administered intravenously into the patient's body. After the operation, it is allowed to drink only a little water (up to 0.5 l). From the second day this restriction is removed. The patient is transferred to clinical nutrition. Diet involves frequent meals, but the portions should be very small. Expansion of the diet occurs gradually.
From the second day it is also allowed to take short walks and do breathing exercises. Each time, the intensity of physical activity should become greater. An exception are situations in which the patient feels unsatisfactory or experiences severe pain.
Sutures are removed 8-10 days after pyloroplasty of the stomach according to Finney. The patient is discharged if his condition is assessed as satisfactory, and the results of laboratory tests do not cause concern.
Possible complications
The likelihood of undesirable consequences is not excluded. But it is important to know that they appear only in isolated cases. Among the complications:
- peritonitis;
- pancreatitis
- internal bleeding;
- violation of the process of evacuation of partially digested food from the stomach;
- chronic diarrhea;
- violation of the integrity of the intestines;
- hernia formation in the incision area.
The risk of complications increases with dehydration, smoking, an unbalanced diet, and obesity. Respiratory diseases, old age, blood coagulation disorders and heart pathologies are also provoking factors.
Finally
During pyloroplasty in Finney, the surgeon enlarges the pathologically narrowed area between the stomach and duodenum. Currently, this method is considered optimal for solving this problem. In addition, it is not associated with a high risk of postoperative complications. The criteria for a successful intervention are a satisfactory condition of the patient, good test results, restoration of normal evacuation of partially digested food.