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04-21-2008, 04:03 PM
q Aim of operation: To remove a big portion of acid secreting area.
qLimits of cutting:
Distal cut ® in the 1st part of duodenum.
Proximal cut ® as high as possible. "leave the fundus only".
qAnastomosis:
Gastrojejunostomy "Billorith II".= Polya operation.
Hoffmeister valve may be added to narrow the stoma and delay evacuation.
Gastrodudenostomy cann't be done Why?
1- Duodenum is a site of adhesion difficult to do Kocherization of the duodenum (Mobilization of it by icising its peritoneal covering at its Rt. border)( Kocher's maneuver) .
2- Wide gap between proximal and distal stump.



What about the ulcer itself ?
1- If the ulcer can be excised ® excise it
2- If it is difficult to be excised ® leave it
3- If there is extensive adhesions interfer with distal cut in 1st part of duodenum ® Do Bancroft's technique:® distal cut is done in the antrum with pealing of antral mucosa down to the duodenum and leave Rt. gastric artery to supply the stump.
Recurrence after subtotal gastrectomy is 2.5%
SOURCE: DR. AYMAN SALEM'S BOOK
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