From the beginning of his medical career, the head of the Department of Surgery No. 3 of the National Medical University named after O.O. Bogomoletsa, Doctor of Medical Sciences, Professor Pavlo Ivanchov drew attention to the fact that operations for the total removal of stomach cancer due to cancer, although they save patients, greatly reduce their quality of life. Especially when it comes to stomach cancer complicated by bleeding. In order to start the digestion process in the absence of a stomach, it is customary to connect the esophagus with a disconnected loop (either according to Roux or according to Brown) – and then the food enters the small intestine directly. This forces the patient to completely change his eating habits after the operation. A person has to take food in small portions, 15-20 times a day, all his life. It is clear that the quality of life under such conditions significantly deteriorates.
In 2008, on the basis of the Department of Surgery No. 3 of NMU, the development of various reconstructive operations after gastrectomy began. Their result was supposed to be the formation of a so-called “artificial stomach” in patients, which would completely replace the reservoir function of the human stomach. And already in 2011, Professor Ivanchov defended his doctoral thesis on the problems of tumor lesions of the stomach complicated by bleeding. It included examples of the successful formation of an “artificial stomach”. More than 1,300 cases of patients with this pathology were analyzed in the work. As a result, surgical tactics for the treatment of patients of this category and options for reconstruction after gastrectomy were developed, including a proposed method of forming an artificial stomach. The first patient, to whom Pavlo Vasyliovych formed an artificial stomach according to the method developed by him on the basis of the department, has been living a full life for 14 years.
Why can such operations be considered unique? Methods of forming an artificial stomach were developed by American surgeons back in the 70s and 80s of the last century. Hunt’s method is considered one of the classic methods. Removal of stomach cancer followed by the formation of an “artificial stomach” requires more time and certain technical skills of the surgeon. Therefore, there were relatively few such operations in the world. And since the 80s, a new, more modern standard for the formation of an “artificial stomach” has not appeared in surgery.
Developments on the basis of the Department of Surgery No. 3 of NMU are the next step in this kind of operations against the background of already existing methods.
“We modernized them, we included various stapling devices, for example, linear and circular staplers, because in those years they simply did not exist. There are also some approaches developed by my teacher academician Petro Dmytrovych Fomin. This, in particular, is a technique of sagittal diaphragma crurotomy, in order to penetrate the posterior interstitium and make wider access to the cardiac part of the esophagus. And this gives us the opportunity to very easily form these esophageal-reservoir anastomoses. Without such skills, it will be very difficult to form an “artificial stomach” and surgeons avoid these operations in various ways.
We at the department have long tested and declared the most successful approaches. We have the necessary technical support and the necessary technical skills. Such operations, we can say, have become routine for us and do not present any difficulties. That’s why we put these operations on stream and are approaching the hundredth in the account. We have several versions of the technical implementation of “artificial stomachs”. The latest version has already undergone the necessary technical improvements. All the weak points of this operation have already been polished and I can say with confidence that it minimizes all possible complications. To everyone, this operation seems fantastic, but if now we do it so skillfully and simply, then it is already available for transferring our experience to other surgeons,” commented Professor Ivanchov.
The Department of Surgery No. 3 of NMU aims to popularize Professor Ivanchov’s method as a reliable method for forming an “artificial stomach” with a clearly developed algorithm. Under the guidance of the professor, Oksana Prudnikova, assistant professor of the department, is currently completing her dissertation on the problems of gastric cancer complicated by bleeding. The dissertation materials will include patients with similar operations. After the successful defense of the thesis, it is planned to convey the techniques for forming an artificial stomach, developed at the department, to a wider audience of doctors – for their introduction into general surgical practice. Master classes on such operations are already held at the department.
Head of the Department of Surgery No. 3 of the National Medical University named after O.O. Bogomolets, professor Pavlo Ivanchov says that when more than five hundred such operations are carried out, we will be able to declare our achievements in international scientific arenas. And the next step will be to perform these operations laparoscopically.
Such achievements are a huge achievement for our University. This testifies to the high potential of the teaching staff, a powerful clinical base, and therefore, it is an opportunity for our students to study in the best modern conditions.
Press center of NMU