Surgery of the Stomach: Indications, Methods, Complications PDF
Preview Surgery of the Stomach: Indications, Methods, Complications
Surgery of the Stomach Indications, Methods, Complications Edited by H.D. Becker, Ch. Herfarth, W. Lierse, and H. W. Schreiber Associate Editors: Th. Effenberger and B. Kremer Illustrator: I. Schaumburg With 520 Figures Springer-Verlag Berlin Heidelberg GmbH Title of the German Edition: Magenchirurgie, hrsg. von Becker/Lierse/Schreiber © Springer-Verlag Berlin Heidelberg 1986 ISBN 978-3-642-88329-3 ISBN 978-3-642-88327-9 (eBook) DOI 10.1007/978-3-642-88327-9 Library of Congress Cataloging-in-Publication Data. Magenchirurgie. English. Surgery of the stomach. Translation of: Magenchirurgie. 1. Stomach - Surgery. 1. Becker, Horst Dieter. II. Title. [DNLM: 1. Stomach surgery. WI 380 MI92] RD540.5.M3413 1987 617'.553 87-32330 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, re-use of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data banks. Duplication of this publication or parts thereof is only permitted under the provisions of the German Copyright Law of September 9, 1965, in its version of June 24, 1985, and a copyright fee must always be paid. Violations fall under the prosecution act of the German Copyright Law. © Springer-Verlag Berlin Heidelberg 1988 Originally published by Springer-Verlag Berlin Heidelberg New York in 1988 Softcover reprint of the hardcover 1st edition 1988 The use of registered names, trademarks, etc. in this pUblication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product Liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. 2124/3130-543210 - Printed on acid-free paper Addresses Editors Prof. Dr. HORST DIETER BECKER Chirurgische UniversiHitsklinik, AbU. fUr Allgemeinchirurgie, Calwer Str., D-7400 Tiibingen Prof. Dr. CHRISTIAN HERFARTH Chirurgische Universitatsklinik, 1m Neuenheimer Feld 110, D-6900 Heidelberg Prof. Dr. WERNER LIERSE Anatomisches Institut der Universitat, MartinistraBe 52, D-2000 Hamburg 20 Prof. Dr. HANS WILHELM SCHREIBER Chirurgische Universitatsklinik, MartinistraBe 52, D-2000 Hamburg 20 Illustrator INGRID SCHAUMBURG Foerstermiihle 8, D-8510 Fiirth Translator TERRY C. TELGER 6112 Waco Way, Ft. Worth, TX 67113, USA Authors AMDRUP, E., Prof. Dr., Kommune Hospital, Gastroenterologist Kirurgisk a.f.d.L., DK-Aarhus BERGER, G., Dr., Chirurgische Klinik im Klinikum Steglitz, Hindenburgdamm 30, D-1000 Berlin 45 EFFENBERGER, TH., Dr., Chirurgische Universitatsklinik, MartinistraBe 52, D-2000 Hamburg 20 FEIFEL, G., Prof. Dr., Chirurgische Universitatsklinik, D-6650 Homburg/Saar GRONINGER, J., Dr., Chirurgische Universitatsklinik, LangenbeckstraBe 1, D-6500 Mainz HARING, R., Prof. Dr., Chirurgische Klinik im Klinikum Steglitz, Hindenburg damm 30, D-1000 Berlin 45 HOLLE, F., Prof. Dr., LindenstraBe 7, D-8000 Miinchen 90 HOLLENDER, L.F., Prof. Dr.Dr.h.c., Centre Hospitalier Universitaire de Haute pierre, 1, Avenue Moliere, F-67098 Strasbourg-Cedex HRYNYSCHYN, K., Dr., Chirurgische Universitatsklinik, MartinistraBe 52, D-2000 Hamburg 20 JOHNSTON, D., MD, Prof., University Department of Surgery, GB - Leeds LSl 3EX VI Addresses KELLER, D., Dr., Centre Hospitalier Universitaire de Hautepierre, 1, Avenue Moliere, F -67098 Strasbourg KRAAS, E., Prof. Dr., Stiidtisches Krankenhaus Moabit, 1. Chirurgische Abtei lung, Turmstra13e 21, D-1000 Berlin 21 KREMER, K., Prof. Dr., Chirurgische Universitiitsklinik A, Moorenstra13e 5, D-4000 Dusseldorf KRONBERGER, L., Prof. Dr., Chirurgische Universitiitsklinik, Auenbrugger Platz 5, A-8036 Graz LAMBRECHT, W., Dr., Chirurgische Universitiitsklinik, Martinistra13e 52, D-2000 Hamburg 20 LEHR, L., Priv.-Doz. Dr., Chirurgische Klinik der Technischen Universitiit, Kli nikum rechts der Isar, Ismaninger Stra13e 22, D-8000 Miinchen 80 OLBE, L., Prof. Dr., Surgical Clinic II, Sahlgrenzka Hospital, S-41345 Goteborg PICHLMAYR, R., Prof. Dr., Department Chirurgie der MHH, Konstanty-Gut schow-Stra13e, D-3000 Hannover 61 REHBEIN, F., Prof. Dr., Emmastra13e 51, D-2800 Bremen 1 ROTHMUND, M., Prof. Dr., Chirurgische Universitiitsklinik, Langenbeckstra13e 1, D-6500 Mainz SCHRIEFERS, K.-H., Prof. Dr., Chirurgische Klinik des Stiidtischen Kranken hauses "Kemperhof', Koblenzer Stra13e 115-155, D-5400 Koblenz SCHUMPELICK, V., Prof. Dr., Chirurgische Universitiitsklinik der RWTH, Pau welsstra13e, D-5100 Aachen VILLAR, H., Prof. Dr., Associate Professor of Surgery, College of Medicine, Department of Surgery, Tucson, Arizona, USA WITTE, J., Prof. Dr., Krankenhauszweckverband Augsburg, Zentralklinikum, Chirurgische Kliniken, Postfach 101920, D-8900 Augsburg Preface "Who masters his stomach has set all the organs right. " (Pythagoras of Samos, ca. 580-496 B.C.) Gastric surgery-for decades seemingly a closed chapter-has undergone a fruitful renaissance in our time. After a brief period of inevitable instability, this move ment became the pacesetter for the emergence of a new and binding consensus. As is so often the case, much of the "new" in gastric surgery is the "old" that has been proven and scientifically refined. Surgery of the Stomach is an operative textbook. Its aim is to present proven surgical procedures on the stomach and proximal duodenum in a step-by-step manner that can be easily grasped by the reader. Coverage centers on the stan dard and alternative procedures used in the everyday practice of gastric surgery. The core of the book is technical detail. Operating techniques are described in concise textual passages with anatomi cally correct illustrations. General preoperative preparation, postoperative care, and special intra- and postoperative complications and pitfalls and ways to avoid them are presented for a comprehensive range of specific procedures. The text and illustrations were developed largely at the operating table and drawn from the personal experience of the authors. Experienced surgeons from both within and outside Europe collaborated in the writing of this book. All were committed to our primary goal of optimizing surgical techniques and improving their safety. Most of the high-quality drawings were supplied by Mrs. 1. Schaumburg; many were prepared from sketches that she made right in the operating room. The illustrations in the chapter on Selective Proximal Vagotomy with Pyloro myoplasty were furnished by Mrs. A. Ruppel and Mrs. N. Cliff-Neumuller. Mr. J. S. Pupp provided the illustrations for several chapters, and Mrs. M. Luck and Mr. R. Helmus gave us their help with miscellaneous tasks. Their excellent cooperation is gratefully acknowledged. We are also grateful to Mrs. M. Hirschmann for her painstaking work in typing the text and captions. We thank Springer Verlag for suggesting the concept of the book, for their confidence and understanding, and for their fine work in the production of this volume. Tiibingen/Heidelberg/Hamburg, Summer, 1988 THE EDITORS Contents 1 Topographic Anatomy of the Stomach and Duodenum H.D. BECKER, W. LIERSE, and H.W. SCHREIBER. With 14 Figures 1 2 Surgical Approaches and Drainage Methods H.D. BECKER. With 7 Figures . . . . . . . 14 3 Surgical Treatment of Positional Abnormalities H.W. SCHREIBER. With 2 Figures . . . . 18 4 Surgical Treatment of Gastric Injuries H.W. SCHREIBER and K. HRYNYSCHYN ... 20 5 Gastrotomy, Gastroenterostomy, Gastrostomy, Local Excisions of the Gastric Wall, Diverticula CH. HERFARTH, E. KRAAS, and H.W. SCHREIBER. With 13 Figures .. 22 6 Billroth I Resection H.D. BECKER. With 29 Figures . . . 35 7 Partial Gastrectomy with Billroth II Resection and Alternative Methods L. OLBE and H.D. BECKER. With 35 Figures ........... 50 8 The Roux-en-Y and Other Anastomoses L. KRONBERGER. With 25 Figures . . . . . . . . . . . . . 71 9 Gastrectomy H.W. SCHREIBER. With 45 Figures . . . . . . . . . . . . . . . . 86 10 Resection of the Cardia H.D. BECKER, K. KREMER, and H.W. SCHREIBER. With 29 Figures . . 113 11 Gastric Reconstruction CH. HERFARTH. With 33 Figures ...... 130 12 Palliative Procedures for Unresectable Gastric Carcinoma CH. HERFARTH and H.W. SCHREIBER. With 11 Figures .. 160 13 Highly Selective Vagotomy with Excision of the Ulcer for Gastric Ulceration D. JOHNSTON. With 11 Figures ............... 167 14 Selective Proximal Vagotomy with Esophageal and Gastric Myotomy H.W. SCHREIBER and V. SCHUMPELICK. With 4 Figures ....... 176 15 The Technique of Nonresective Ulcer Surgery F. HOLLE. With 23 Figures . . . . . . . . . . . . . . . . ... 179 X Contents 16 Selective Gastric Vagotomy E. AMDRUP. With 15 Figures . . . . . . . . . . . . . . . . . . 210 17 Thoracic Vagotomy R. PICHLMA YR and L. LEHR. With 11 Figures . . . . . . . . . . . 217 18 Truncal Vagotomy H.D. BECKER. With 11 Figures ................. 223 19 Pyloric Drainage L.F. HOLLENDER and D. KELLER. With 11 Figures ..... 228 20 Anatomic Reconstruction of the Esophagogastric Junction M. ROTHMUND and J. GRONINGER. With 5 Figures ......... 237 21 Antireflux Operations G. FEIFEL and J. WITTE. With 30 Figures ... 241 22 Operations on the Stomach and Cardia for Esophageal Varices H.D. BECKER. With 11 Figures .............. 253 23 Gastric Procedures in Morbid Obesity H.V. VILLAR. With 11 Figures .... 258 24 Operations on the Duodenum (Excluding the Papilla of Vater) H.W. SCHREIBER. With 8 Figures ........... .... 264 25 Operative Treatment of Gastric and Duodenal Hemorrhage H.D. BECKER and K.H. SCHRIEFERS. With 12 Figures ... . 274 26 Operative Treatment of Perforations of the Stomach and Duodenum H.W. SCHREIBER. With 3 Figures ................ 282 27 Operations on the Stomach and Duodenum in Children F. REHBEIN and W. LAMBRECHT. With 30 Figures . . . . . . 286 28 Remedial Operations on the Stomach B. KREMER and H.W. SCHREIBER. With 48 Figures ........ 300 29 Postoperative Complications and Postoperative Care R. HARING and G. BERGER. With 33 Figures 330 Subject Index . . . . . . . . . . . . . . . . . . 367 1 Topographic Anatomy of the Stomach and Duodenum H.D. BECKER, W. LIERSE, and H.W. SCHREIBER The upper abdominal cavity contains the stomach anterior wall of the omental bursa (lesser peritone and duodenum; the liver, gallbladder, and pancre al sac). This cavity is bounded behind by the parie as, which arise from the embryonic duodenum; tal peritoneum of the posterior abdominal wall; and the spleen, which arises embryonically in the the pancreas, the superior pole of the left kidney, dorsal mesogastrium. and the adrenal gland are palpable on the left (Fig. 1.6). The roof of the omental bursa is formed by the lower margin of the liver in the region of Topographic Anatomy of the Stomach the quadrate lobe and by part of the diaphragm in the region of the cardia; the transverse mesoco Three-fourths of the gastric organ is located in lon forms the floor. The omental bursa can be the left hypochondriac region and one-fourth in reached by any of several routes: the epigastric regio;!. Normally the field for opera tive exposure of the stomach is relatively small, • Through the gastrocolic ligament, being bounded by the left costal arch, the liver, • Through the lesser omentum, and the transverse colon. The position of the stom • Between the greater omentum and transverse ach depends on its state of fullness and contraction colon, and also on the position of the diaphragm. • Through the foramen of Winslow, For convenience the stomach is subdivided into • Through the transverse mesocolon. the cardia, which is adjacent to the esophagus; the fundus, whose proximal end is termed the gas tric fornix; the body, the portion that contains the greater and lesser curvatures and is chiefly re Esophagus Mediastinal pleura sponsible for acid secretion; and, distal to the an gular inci ur , the antrum, the pylorus, and pyloric canal (Fig. 1.1). The proximal duodenum consists of the duodenal bulb, which is about 2 em in length, and the descending portion of the duode num. The posterior surface of the stomach, the gastro colic ligament, and the lesser omentum form the Visceral Fundus peritoneum Duodenal bulb Body Fig. 1.1. Schematic illustration of the parts of the terminal esophagu, tomach, and duodenum. (After Las rich and Prevot 1981)
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