STOMACH RESECTION Position of the stomach in

STOMACH RESECTION

Position of the stomach in the abdominal cavity. 1 — lig. hepatogastricum; 2 — lien; 3 — ventriculus; 4 — lig. gastrocolicum; 5 — duodenum; 6 —lig. hepatorenale; 7 — foramen epiploicum (Winslovi); 8 — lig. hepatoduodenale; 9 — vesica fellea; 10 — hepar; 11 — lig. teres hepatis.

Anatomic division of the stomach: 1. Cardia (pars cardiaca); 2. Fundus gastricus (fornix) – fundus of stomach; 3. Corpus gasricum – body of stomach; 4. Pars pylorica – pyloric part of stomach; - antrum pyloricum – pyloric antrum; - canalis pyloricum – pyloric canal; 5. Pylorus.

• Paries anterior; • Paries posterior; • Curvatura minor – lesser curvature of stomach; • Curvatura mayor – greater curvature of stomach; • Incisura cardialis; • Incisura angularis;

Anatomic division of stomach. 1 — fundus ventriculi; 2 — pars cardiaca; 3 — curvatura ventriculi major; 4 — corpus ventriculi; 5 — pars pylorica; 6 — antrum pylori; 7 — ostium pyloricum; 8 — curvatura ventriculi minor; 9 — ostium cardiacum.

Roentgenologic division of the stomach : 1. Saccus digestorius - Fundus gastricus (fornix); - Corpus gasricum; - Sinus ventriculi; 2. Canalis egestorius - Antrum pyloricum; - Pylorus.

Roentgenologic division of the stomach. 1 — polus cranialis; 2 — formix; 3 — pars cardiaca; 4 — corpus; 5 — sinus; 6 — polus caudalis; 7 — antrum pylori; 8 — pylorus: 9 — bulbus duodeni; 10 — angulus; 11 — cardia; 12 — oesophagus.

Ligaments of the stomach. А — anterior surface; B — posterior surface. 1 — gastropancreatic ligament; 2 — pyloropancreatic ligament; 3 — gastrophrenic ligament; 4 — gastrosplenic ligament; 5 — gastrocolic ligament; 6 — hepatoduodenal ligament; 7 — hepatogastric ligament. = lesser omentum

Висцеральные ветви брюшной части аорты: 1 – pars abdominalis aortae; 2 – truncus coeliacus; 3 – a. gastrica sinistra; 4 – a. lienalis; 5 – a. hepatica communis; 6 – a. hepatica propria; 7 – r. dexter a. hepaticae propriae; 8 – r. sinister a. hepaticae propriae; 9 – a. cystica; 10 – a. gastrica dextra; 11 – a. gastroduodenalis; 12 – a. gastroepiploica dextra; 13 – a. gastroepiploica sinistra; 14 – a. pancreaticoduodenalis superior; 15 – a. mesenterica superior; 16 – a. colica media; 17 – a. colica dextra; 18 – a. ileocolica; 19 – a. appendicularis; 20 – arcus Riolani; 21 – a. mesenterica inferior; 22 - a. colica sinistra; 23 – a. sigmoidea; 24 – a. rectalis superior; 25 – a. iliaca communis; 26 – a. iliaca externa; 27 – a. iliaca interna.

Система воротной вены: 1 – vena portae hepatis; 2 – v. cystica; 3 – v. gastrica sinistra; 4 - v. gastrica dextra; 5 - v. praepylorica; 6 - v. mesenterica superior; 7 - v. splenica; 8 - vv. jejunales; 9 - vv. ileales; 10 - v. gastro-omentalis (epiploica) dextra; 11 - vv. pancreaticae; 12 – vv. раncreaticoduodenales; 13 - v. ileocolica; 14 - v. appendicularis; 15 - v. colica dextra; 16 - v. colica media (intermedia); 17 – vv. pancreaticae; 18 - vv. gastricae breves; 19 - v. gastroomentalis (epiploica) sinistra; 20 - v. mesenterica inferior; 21 - v. colica sinistra; 22 - vv. sigmoideae; 23 - v. rectalis superior; 24 - v. iliaса communis; 25 - v. sacralis mediana; 26 - v. iliolumbalis.

Blood supply of the stomach. Lesser omentum and parietal peritoneum of the omental bursa are partly dissected. 1 — lien; 2 — aa. et vv. gastricae breves; 3 — a. et v. gastrica sinistra; 4 — truncus coeliacus; 5 — a. lienalis; 6 — a. hepatica communis; 7 — a. et v. gastro-epiploica sinistra; 8 — ventriculus; 9 — omentum majus; 10 — a. et v. gastro-epiploica dextra; 11 — duodenum; 12 — a. et v. gastrica dextra; 13 — a. et v. gastroduodenalis; 14 — ductus choledochus; 15 — v. cava inferior; 16 — v. portae; 17 — a. hepatica propria; 18 — hepar; 19 — vesica fellea.

1 - lig. coronarium hepatis; 2 - lig. hepatogastricum; 3 — foramen epiploicum; 4 -pancreas; 5 - spatium retroperitoneale; 6 - duodenum; 7 - radix mesenterii; 8 - jejunum ; 9 - mesocolon sigmoideum; 10 -rectum; 11 - excavatio rectovesicale; 12 - vesica urinaria; 13 -ileum ; 14 - omentum majus; 15 - peritoneum parietale; 16 - cavum peritonei; 17 - colon transversum; 18 - mesocolon transversum; 19 - bursa omentalis; 20 - ventriculus; 21 - hepar; 22 - diaphragma.

Types of approaches 1 – right transrectal incision (approach); 2 – upper middle incision; 3 – transversal incision; 4 – combined upper middle incision; 5 – combined transversal incision

1 — 1/2 of stomach; 2— 2/3 of stomach (in ulcers) border – transversal branch of left gastric artery that must be kept ; 3 — 3/4 of stomach (border passes from cardia to the splen’s lower pole) ; 4 — 4/5 of stomach; 5 —total. 3, 4, 5 – in cancers

Theodor Billroth (1829 - 1894) 29/01/1881 – 1 st stomach resection

Billroth I

Roux

Billroth II

Billroth II 1 Mobilization of the stomach: dissection of thr greater curvature of stomach.

2 Mobilization of the stomach: partial dissection of lig. gastrocolicum, dissection of a. et v. gastro-epiploica sinistra.

3 Mobilization of the stomach: dissection of a. et v. gastroepiploica dextra. 1 — a. et v. gastroepiploica sinistra; 2 — lig. gastro-colicum; 3 — pancreas; 4 — a. et v. gastroepiploica dextra; 5 — ventriculus.

4 Mobilization of the stomach: dissection of the branches of a. et v. gastroduodenalis. 1 — ventriculus; 2 — pancreas; 3 — a. et v. gastroduodenalis; 4 — a. et v. gastroepiploica dextra.

5 Mobilization of the stomach: Forming an opening in the lesser omentum.

6 Mobilization of the stomach: dissection of the lesser omentum between the forcepses.

7 Mobilization of the stomach: dissection of the а. et v. gastrica sinistra. 1 — stomach; 2 — a. et v. gastrica sinistra; 3 — omentum minus; 4 — a. et v. gastriсa dextra.

8 Mobilization of the stomach: dissection of the a. et v. gastrica dextra. 1 — stomach; 2 — a. et v. gastrica dextra; 3 — omentum minus.

9 One loop of the jejunum is taken through opening in the mesentery transverse colon.

10 Dissection of the duodenum between two forcepses.

11 Handling of the duodenal stump.

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Handling of the duodenal stump using device “УКЛ-60”.

16 Removing of the stomach (part of the stomach)

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24 Suturing the anastomosis with the edges of the opening in the mesentery transverse colon.

Vagotomy

These are the most common epithelial polyps of the stomach.

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