Surgical treatment of postbulbar duodenal ulcer

Potbulbar localization was observed in 115 of 2142 patient operated for duodenal ulcer (5.4%). In most of the patients the disease has a severe clinical course, does not lend itself to conservative treatment and is often complicated by bleeding, penetration, stenosis. In 90% of the cases postbulbar ulcers penetrate into the pancreas head and hepatoduodenal ligament. The experience has shown that wider introduction of Billroth-I resection is a prerequisit for the improvement of postoperative results.     

十二指肠球部后壁穿透性溃疡的手术治疗

目的提高十二指肠球部后壁穿透性溃疡的手术治疗水平。方法回顾分析我科于1986年7月至2006年1月间收治的十二指肠球部后壁穿透性溃疡167例所采取的手术处理原则、手术术式的选择、治疗的结果。结果本组167病例均采取不同手术术式,166治愈。死亡1例,死于吻合口大出血。结论合理选择术式可提高治愈宰及减少并发症,Bancroft术式、Graham法及Nissen法为治疗该病例的主要术式。     

Surgical treatment of patients with duodenal ulcer]

Ulcer incidence in the Crimeahas increased during the last 9 years from 118.4 to 185.7 cases per 10,000 of adult population, being higher in South Coast and in mountains. From 125 patients with duodenal ulcer after conservative treatment only 12.8% have recovered (follow up for 8-10 years). 29.6% of patients underwent surgery; 1.6%--died without operations of ulcer, 35.2%--needed elective treatment. From 97 patients who died during 4 years of ulcer in Simferopol, 25 (25.8%) were not operated. They were aged and very old patients with long history of the disease. Among 9412 operations for ulcer there were 4.17% of lethal outcomes in perforated ulcer and 11.5%--in bleeding (22.18% being at the peak of hemorrhage); 1.45%--after elective resection of the stomach, 0.79%--after organ-saving operations with vagotomy, in SPV--0.56%. According to general hospital surgery data, there were no lethal outcomes after SPV and SPV with pyloroplasty (295 patients). As a conclusion it is stated, that surgery in ulcer should be made earlier, before complications.     

Surgical treatment of chronic pancreatitis associated with duodenal ulcer

In combination of the ulcer disease and pancreatitis with the aim to achieve simultaneous suppression of gastric hypersecretion and reduction of the secretory pancreatic activity, a method of operation--selective proximal vagotomy added by cutting the celiac branch of the right vagal trunk has been developed. In 42 patients, operated on using the suggested method, the pancreatic secretion, acid production and gastric motility were studied. At observation of up to 7 years, the excellent and good results were noted in 88.09% of patients.     

Surgical treatment of duodenal ulcer complicated by mechanical jaundice

Operations were performed on 41 patients with duodenal ulcer which was the cause of obstruction of the bile ducts. Many patients also suffered from other chronic and acute complications of peptic disease of a long duration. Preliminary laparoscopic decompression of the gallbladder was conducted whenever possible. When the operative intervention was undertaken in obstructive jaundice preference was given to resection of the stomach or organ-preserving operations which were combined with correction of the bile draining ducts.     

Surgical treatment of gastric and duodenal ulcer disease with chronic duodenal obstruction

One hundred and twenty-nine surgeries were performed from 1990 to 2001 for gastric (50) or duodenal (79) ulcers with chronic duodenal obstruction. Resection of 1/2 of the stomach by Bilrot-I was performed in 118 patients, pylorus-saving resection with creation of areflux valve in duodenal bulb--in 5, selective proximal vagotomy with duodenoplasty--in 6 patients. In early postoperative period complications were seen in 10 (10.9%) patients, postoperative lethality was 0.8% (one patient died). There was no insufficiency of anastomotic sutures. Postoperative stay was 11.3 +/- 1.5 days. In remote period after surgery symptoms of chronic pancreatitis was in 2.3% patients, but there were no symptoms of duodenostasis. Roentgenological symptoms of compensated duodenal obstruction were seen in 2 patients operative on for decompensated duodenostasis. These patients had no complaints.     

Surgical treatment of gastroesophageal reflux disease combined with duodenal ulcer

Operations for ulcer disease of the duodenum were performed on 696 patients. In 112 (16.1%) patients there were symptoms of insufficient obturating function of the cardia, which was considered to be an indication to antireflux simultaneous operation on the cardia. The indications were worked out for the decision on operative methods in patients with ulcer disease of the duodenum in combination with gastroesophageal reflux disease. Methods of resection were used in 88 (78.5%) patients, videolaparoscopic selective proximal vagotomy with an original means of fundoplication--in 24 (21.5%) patients. Good and excellent long-term results after operation were noted in 95.5% of the patients.     

Surgical treatment of duodenal ulcer in elderly and aged patients

Choice of treatment of duodenal ulcer in elderly and aged patients is discussed. Literature demonstrate high risk of recurrences even in adequate systemic drug treatment. In patients of this age group early organo-saving operations must be performed before development of complications. Results of selective proximal vagotomy in 62 patients aged from 60 to 82 years confirm efficacy and minimal risk of this surgery.