MODIFIED LAPAROSCOPIC ESOPHAGOGASTRIC DEVASCULARIZATION

Background. Transabdominal gastroesophageal devascularization is a technically feasible backup operation for most general surgeons in case of failure of endoscopic prophylaxis of bleeding from esophageal varices. There is an emerging trend in the development of laparoscopic technologies in the surgical correction of complications of portal hypertension. Purpose. Assessment of the clinical efficacy of laparoscopic esophagogastric devascularization in its own modification. Material and methods. In the period from 2009 to 2020, the results of treatment of 31 patients were studied. The patients were divided into 2 groups by the method of simple randomization. In the control group, surgery was performed in a standard way, in the main group - in the modification we proposed. Results. The use of our proposed technological methods when performing the stage of transection of the abdominal esophagus during laparoscopic esophagogastric devascularization in its own modification reduced the frequency of technical difficulties at this stage, which caused conversions, anastomotic leakage and other intra and postoperative complications. In the long-term period, there was a decrease in the degree of esophageal varices, a decrease in the frequency of recurrent bleeding and mortality, as well as an improvement in the quality of life in patients after a modified operation in comparison with the standard technique. Laparoscopic esophagogastric devascularization in our modification shows better results as a method of secondary prevention of bleeding from esophageal varices in cirrhosis of the liver in patients with a high risk of recurrence than the use of endoscopic sclerosis of esophageal varices, is characterized by a lower incidence of repeated episodes of bleeding from esophageal varices and less lethality. Conclusions. Based on the analysis of the immediate and long-term results of the use of laparoscopic esophagogastric devascularization in its own modification in the clinic, it should be noted the reproducibility of the surgical intervention, its effectiveness and safety.