Surgical treatment in chronic gastroduodenal ulcers

Operative treatment was carried out in 1197 patients with chronic gastroduodenal ulcers. Among the most frequent complications of the ulcers there were penetration of the III-IV degree, compensated, subcompensated and decompensated pyloroduodenal stenosis. The operative interventions included Billroth-II resections of the stomach in modification of Hofmeister-Finsterer, Billroth-I, with saving the pyloric sphincter, after Roux and gastrectomies. Postoperative complications developed in 127 (10.6%) patients, postoperative lethality was 0.7%. Excellent and good long-term results were noted in 846 (94.5%) patients, in 14 (1.6%) patients they were estimated as satisfactory and in 35 (3.9%) as unsatisfactory. The causes of unsatisfactory results were recurrent ulcers (0.7%), peptic ulcer of the gastroenteroanastomosis (0.6%), dumping-syndrome of a severe and medium degree (1.5%), diarrhea of a severe degree (0.3%) and erosive-ulcerous reflux-esophagitis (0.3%).     

Surgical treatment of perforative gastroduodenal ulcer in patients living in a catastrophic flood zone

In a period of catastrophic flood in 1998 and 2001 yrs there was noted the enhancement of general quantity of patients with gastroduodenal ulcer disease as well as with complicated course, including gastroduodenal ulcer perforation. In the period of flood in Zakarpattya in 2001 the quantity of patients, who were admitted to hospital, to Tyachiv and Vinogradiv central district hospitals in particular, too late, was enhanced as twice. In conditions of extreme situation it is expedient to conduct prophylactic treatment of patients, who are staying under the dispensary observation for gastroduodenal ulcer disease. Improvement of the surgical treatment results in patients with gastroduodenal ulcer disease complications in the disaster zone may be achieved due to accurate organization and coordination on all the stages of medical care to population, application of modern endoscopic technologies.     

Surgical treatment of complicated gastroduodenal ulcers

Results of surgical treatment of complicated forms of gastroduodenal ulcers in 225 patients were summed up. The patients were operated upon using different variants of gastric resection. Results of the surgical treatment were followed-up during the period from 2-3 months up to 3-5 years. Promising results of the operative treatment of patients with complicated forms of gastroduodenal ulcers using tubular resections of the stomach allow to widely recommend them for surgical practice.     

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.     

Surgical treatment of bleeding gastroduodenal ulcers

The active-temporizing tactics accepted in the clinic, which is based on determination of the indications for operative treatment according to the endoscopic classification, abandonment of hemostatic therapy for elderly and senile individuals, active antiulcerous therapy, and consideration for immunological reactivity made it possible to reduce total mortality among patients with ulcerous gastroduodenal bleeding from 12.6% to 4.5%.     

Surgical treatment of perforated gastroduodenal ulcers

Experience in surgically treating 820 patients aged 15 to 83 years who had perforated gastroduodenal ulcers is summarized. In 576 (70.2%) patients the perforated hole was sutured. Thirty-four (4.2%) patients underwent gastrectomy and 210 (25.6%) had vagotomy with drainage operation on the stomach. After surgery 39 (5.6%) patients died. Mortality rates after ulcer suturing, gastrectomy, and vagotomy with gastric drainage were 6.2, 2.7, and 0.9%, respectively. Recurrent ulcer occurred in 57.3% after ulcer suturing, in 2.9% after gastrectomy, and in 9% after gastric drainage vagotomy. By taking into consideration the high rate of recurrent ulcers following palliative interventions, the author proposes to expand indications for radical surgery in patients with serous and serofibrinous forms of general peritonitis in the reactive phase.     

Vagotomy in the treatment of gastroduodenal ulcers in middle-aged and elderly patients

Experience with the treatment of 190 patients with a complicated ulcer disease of the stomach and duodenum in elderly and senile patients is presented. In 115 of the patients gastric resection was performed. Different kinds of vagotomy were used in 75 patients. Postoperative complications after vagotomy were noted in 9,3% of the cases, after gastric resection in 40%. No lethal outcomes followed vagotomy. Lethality rate after gastric resection was 9,6%.     

Surgical treatment of perforated and bleeding gastroduodenal ulcers

Twelve-year experience of surgical treatment of gastroduodenal ulcers complicated by perforation and bleeding is analyzed. Modern antisecretion and antihelicobacter drugs have changed conception of pathogenesis and treatment of ulcers. Choice of surgical method is the key moment of surgical policy. Perforation and bleeding in ulcer disease are life-threatening complications especially in elderly patients with concomitant diseases. In these patients technical simplicity and tolerance to surgery are very important.     

Surgical treatment of multiple and associated gastroduodenal ulcers]

Operated on were 53 patients with multiple and associated gastric and duodenal ulcers, which were characterized by a high rate of complications (54.7%) and low effectiveness of the conservative treatment. Gastric resection with removal of the pathologically changed areas was the main operation. After the operation, 2 (3.7%) patients died.     

Surgical treatment of acute cholecystitis in elderly and senile patients]

There were analyzed the results of treatment of 69 elderly and senile patients, operated on for an acute calculous cholecystitis, in 19 of whom cholecystectomy, using miniapproach was performed. The performance of an assisting manipulating channel, application of oblique-changing puncture of gall bladder and of special instruments were proposed to improve technical condition of cholecystectomy performance while usage of miniapproach, its rational exploitation and reduction of intra- and postoperative complications occurrence.     

Treatment of patients with perforative gastroduodenal ulcer

Social and medical aspects of unsatisfactory results of treatment of patients with perforative gastroduodenal ulcer (GDU) were analyzed. There was shown, that social reasons cause not only untimely diagnosis of this severe complication, but they are also slowing down the elaboration and improvement of pathogenetically substantiated methods of operative intervention. While analyzing results of surgical treatment of 590 patients with perforative GDU, of whom in 53 truncal vagotomy was performed, in 241--selective vagotomy, in 296--selective proximal (SPV), there was established, that SPV under condition of serotonin adipinate application in early postoperative period, influencing the gut smooth muscles, constitutes most effective operative intervention.