The late results of surgical treatment in patients with perforated gastroduodenal ulcers]

It was shown that suturing perforative ulcers of the stomach and duodenum gives bad outcomes in more than 52% of the patients. More than half of such patients continue suffering from the ulcer and its complications, every fifth patient needs future radical reoperation. The most frequent indication for reoperation is a recurrent ulcer and stenosis of the pyloric area of the stomach. Somewhat better results of simple suturing the ulcer are observed in patients aged 15-20 years. The maximum amount of unfavourable results (60%) are noted in young patients aged 21-30 years. Perforation of "dumb" gastroduodenal ulcers was followed by a considerable amount (43.5%) of unsatisfactory results of treatment which often required reoperations. Truncal vagotomy with the dissection of the ulcer and pyloroplasty cures the disease and its complications in 85.2% of patients with perforative gastroduodenal ulcers. Somewhat worse results of this operation are noted in patients aged 21-30, considerably better outcomes in patients older than 50. In them the amount of excellent and good results is 67% and 94.2% correspondingly.     

The immediate and late results of Billroth-I gastric resection with the application of the single-row suture]

An experience with gastric resections in 942 patients with ulcer disease of the duodenum is presented. Billroth-I resection was used in 760 patients (81%). The posterior wall of the gastroduodenal anastomosis was formed with the help of a one-row blanket catgut suture in 118 of these patients. Complications at the postoperative period were noted in 10 patients (8.5%). No lethal outcomes followed. Good long-term results in patients with Billroth-I resection of the stomach with a one-row suture of the posterior wall of the gastroduodenal anastomosis were noted in 98.6% of the cases.     

The immediate results of laparoscopic treatment in perforated gastroduodenal ulcers

The article presents an analysis of immediate results of laparoscopic interventions (suturing, vagotomy) in 40 patients with perforated ulcers in the pylorobulbar zone. Postoperative complications were noted in 7.5% of the patients. There were no lethal outcomes. The authors recommend wider introduction of the laparoscopic technology as a method of optimization of surgical treatment for perforated ulcers.     

Pylorus-preserving gastric resections in gastroduodenal ulcers]

The article analyses the results of pylorus-preserving resections of the stomach in 116 patients among whom 80 had gastric ulcer, 29 ad duodenal ulcer, and 7 had gastroduodenal ulcers. Changes of acidity and motor-evacuation function of the gastric stump were studied according to the method of pylorus-preserving resection. The late-term results of treatment in follow-up periods of 2 to 5 years are shown, they were found to be good in 96.6% of patients treated by operation and poor in 1.7%. It is noted that the function of the gastric stump is better when the vagus innervation of the pylorus is preserved. Mediogastric resection with selective proximal vagotomy in patients suffering from duodenal ulcer with a superacidic stomach led to stable normalization of acid production, which was a reliable measure for the prevention of a recurrent ulcer.     

Results of stomach resection with Roux gastrojejunostomy for gastroduodenal ulcers]

In a follow-up study operative risk, postoperative functional disorders and incidence of anastomotic (recurrent) ulcer after partial gastrectomy with Roux-en-Y gastrojejunostomy for gastroduodenal ulcer were evaluated in 52 patients. Lethality for elective treatment was 0 and for emergency surgery (ulcer bleeding) 16.7%. 29.5% of the patients reported postoperative functional disorders. Because Roux-en-Y reconstruction prevented duodenogastric reflux, intragastric pH was low (median 2.2) and in the absence of ulcer protective, neutralizing reflux anastomotic ulcer occurred in 15.9% of the patients. With regard to the high rate of recurrent ulcer Roux-en-Y reconstruction after partial gastrectomy for primary ulcer surgery should be avoided and reconstruction procedures preferred, which guarantee duodenogastric reflux.     

Fibrogastroduodenoscopy in the evaluation of late results of suturing perforated gastroduodenal ulcers

Results of a dynamic endoscopic examination of 213 patients after operations of suturing perforating gastric and duodenal ulcers are described. Stable healing of the ulcer was obtained in 20.2% of the patients. In 79.8% of the patients the ulcer failed to heal or recidivated. A comparison of roentgen findings and results of endoscopic examinations has shown that roentgen analysis gave the correct diagnosis but in 44.7% of the patients examined.     

Early reoperations after resection of stomach in gastroduodenal ulcers]

The material is based on the 20 years' experience in urgent surgical treatment of 2146 patients with gastroduodenal ulcers (GDU). 120 patients of them underwent relaparotomy. The main reasons for the repeated operations were insufficiency of the sutures of the duodenal stump, peritonitis, bleeding, abscesses of the abdominal cavity. Owing to new tactics of surgical treatment for GDU the authors managed to reduce the number of relaparotomies from 9.3 to 3.7% and total mortality rate from 5 to 0.7%.     

Subtotal Billroth-I gastric resection in cancer. The technic and the immediate results]

An analysis of literature data and results of operations on 150 patients with gastric cancer enabled the authors to make a conclusion that subtotal Billroth-I resection of the stomach with correct indications is more preferable as compared with the Billroth-II method. A contraindication for it is considered to be not technical problems of putting gastroduodenal anastomosis but spread of the tumor to the pylorus and duodenum. Based on an examination of preparations of the lymph nodes taken during extended lymphadenectomy performed in 34 patients the authors made a conclusion of its necessity in patients with not large primary tumors as well.     

Surgical treatment of patients with perforating gastroduodenal ulcers]

Under analysis were the results of treatment of 267 patients with perforating gastroduodenal ulcers for the period from 1992 till 1997. Radical operations were fulfilled in 86% of the patients. Suture of the perforation and selective proximal vagotomy were performed in 118 patients with ulcers of the duodenum having no intraoperative signs of duodenostasis, in the others resection of the stomach was used. Palliative operations (suturing the perforation) were performed in 15% of the patients. General lethality was 3.7%, postoperative--3%. Excellent and good results were obtained in 95.5% of the patients.     

The results of the endoscopic diathermy coagulation of hemorrhaging gastroduodenal ulcers]

The authors analysed the results of endoscopic diathermy coagulation of bleeding acute gastroduodenal ulcers in 83 patients; in 47 of them the follow-up period ranged from 12 months to 9 years. A stable hemostatic effect was achieved in the early periods after coagulation of the acute ulcers in 76% of cases. The frequency of recurrent bleeding was found to be directly dependent on the degree of the blood loss. Recurrent bleeding from acute ulcerations of the gastric mucosa in the late-term period was discovered authentically in only one patient. It was linked with medication with brufen for a long duration. Thus, endoscopic diathermy coagulation produced good results in arresting bleeding from acute gastroduodenal ulcers, particularly in patients with a very high operative risk.     

Etiology of acute gastric perforations following suturing of gastroduodenal ulcers]

Data concerning 6 patients who underwent suturing of perforating ulcer and developed an acute stomach perforation postoperatively (4 cases) and acute necrosis of the stomach wall at the site of the suture (2 cases), are analyzed. Besides, the results of experiments on 10 animals are set forth. The author has come to the conclusion that acute thrombophlebitis of the subserous stomach veins constitutes the cause of the above-mentioned complications.     

Immunologic reactivity in patients with gastroduodenal ulcers

Immune system factors were studied in 158 patients with ulcer disease of the stomach and duodenum before and after different operative procedures. More pronounced alterations of immune reactivity as compared with the parameters in patients with noncomplicated ulcer disease were found which manifested themselves in decreased indices of cell immunity, activation of processes of autoallergization, inhibition of nonspecific factors of defense.     

Adhesive intestinal obstruction in the light of immediate and late results]

The immediate and late results of surgery for adhesive intestinal obstruction were followed up in 235 patients. For prophylaxis of intestinal hypodynamia it is recommended to inject 0.25% novocain solution intraabdominally in the postoperative period. It is found that such kind of injections prevent peritoneal adhesions. Intraperitoneal injections of 0.25% novocain solution yield favourable and satisfactory results in 86.3% of cases, while without using novocain good and satisfactory results were noted only in 49.1%.