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.     

Choice of the operation for perforated ulcers of the stomach and duodenum

Actual questions of diagnostics and treatment of 776 patients with perforated gastroduodenal ulcers are discussed. The most informative method of the diagnosis, particularly covered perforation, is laparoscopy. Decision on the operation must be individually grounded. Radical operations were performed in 599 patients with 2% postoperative lethality. Lethality after suturing of the perforation was 10.3%, after resection operations--4.1%, after suturing the perforation in combination with selective proximal vagotomy--0.3%.     

Diagnosis and surgical treatment of perforated ulcers of the stomach and duodenum

An analysis of treatment of 102 patients with perforated ulcers of the stomach and duodenum allowed to give a positive estimation of different combinations of subsidiary instrumental methods of examination (fibrogastroscopy, laparocentesis, fibrogastroscopy + laparocentesis etc.) in diagnosis of the disease. It was noted that these methods substantially improve the differential diagnostics and can be widely used in clinical practice.     

Gastric resection after the suturing of perforated ulcers]

The article deals with the authors' experience in reoperations for complications of peptic ulcer occurring after suturing of a perforation. The stomach was resected in 237 patients, after Billroth I in 71.3 and after Billroth II in 28.7% of cases. The indications for operation were as follows: recurrent perforation, stenosis, penetration, bleeding from the ulcer, as well as peptic ulcer of the gastroenteroanastomosis. Total mortality rate was 1.26%; it was higher in the Billroth II operation (3%). The authors analyse the specific features of surgical interventions after closed penetrating ulcers, which make performance of the principal moments of gastric resection and prevention of possible complications easier. Preference is given to the first method of gastric resection which was applied in 70% of cases. The peculiarities of formation of the gastroduodenal anastomosis during a adhesive process and the main contraindications for its establishment are described.     

Immediate and late results of selective proximal vagotomy in pyloroduodenal ulcers

Selective proximal vagotomy (SPV) was performed in 435 patients whose age ranged from 16 to 80. The isolated variant of SPV was applied in 130 and SPV with a stomach draining operation was conducted in 305 patients; 320 patients were examined after the operation in follow-up periods of 7 years and more. Postoperative lethality was 0.6%. A recurrent ulcer was revealed in 4.3% of patients. The causes of the recurrence are indicated. The results were found to be excellent and good in 76%, satisfactory in 16.9%, and poor in 7.1% of the examined patients.     

A methods of laparoscopic suturing of perforated pyloro-bulbar ulcers

The article describes a method of laparoscopic suturing perforated ulcers of the pylorobulbar zone. The elements of all steps of the operation are analyzed including the places of introducing the trocar, the method of putting the intracorporeal stitches, means of sanitation and drainage of the abdominal cavity. The method was successfully used in operations on 43 patients with perforated ulcers without any complications.