RECONSTRUCTIVE-RECOVERY ORGAN-SPARING AND ORGAN- PRESERVING OPERATIONS FOR RECURRENT DUODENAL ULCERS

Aim. Development of modern and effective methods of organ-sparing and organ- preserving operations in case of recurrence of duodenal ulcer. Materials and methods. The results of treat-ment of 119 patients with duodenal ulcer disease who had previously undergone surgery were analyzed: suturing of perforated duodenal ulcer - 70.7%, suturing of bleeding ulcer - 12.6%, SPV, STV with pyloroplasty - 10.0%, isolated SPV - 6.7%. Among the complications of recurrent ulcers were: pyloroduodenostenosis - 52.9%, ulcerative hemorrhage - 20.3%, re-perforation - 9.2%, combined complications of recurrent ulcer 17.6%. Additional research methods that were used: dy-namic EFGDS control; ionobalonotensiokinesiography; local gastric circulation by the method of L.Ya. Koval-chuk (1984, 1987), tetrapolar rheogastrography; research of general and local hemostasis in conditions of hemor-rhage (tissue thromboplastin); study of morphological changes in peritonitis. Results. The reasons for the recurrence of ulcers were: underestimation of indications for radical and conditionally radical surgical interventions during the first intervention; inadequate drainage operation; leaving an ulcerative substrate within the digestive tract; defects of operating equipment. The list of reconstructive operations from 119 patients whom previously were performed non-resection surgery: SPV + ulcer excision + duodenoplasty - 70 pa-tients (58.8%), revagotomy + pyloro or duodenoplasty - 14 (12.7%), SPV + segmental corporate resection stom-ach + pyloro- or duodenoplasty - 25 (21%), gastrectomy by Bilrot-1 - 5 (4.2%), gastrectomy by Gakker-Balfour - 5 (4.2%). organ-sparing and organ- preserving operations were performed in 109 patients - 91.6% of cases. In patients with decompensated duodenostenosis after previous surgery, the clinic has developed organ-sparing surgery after a preliminary study of changes in the thickness of the muscular layer of the body and the antrum of the stomach in simulated decompensated pyloroduodenosis. Resection of the gastrodilated, non-functioning segment of the stomach involved preservation of the antral segment with duodenoplasty and gastro-gastroanastomosis. In recent years, the frequency of suturing perfo-rated ulcers has decreased significantly and is only 3.8% of all operations for perforated ulcers. This is justified by the expansion of indications for conditionally radical surgical interventions based on the results of an experi-mental researches of comparative assessment of morphological changes of tissues and organs under conditions of 18 or more hours of peritonitis. In 17.6% of combined complications, this type of organ-sparing operation has been developed, which includes excision of the ulcer with duodenoplasty, segmental-corporal resection with gastro-gastroanastomosis. Given the types of activity of the ulcer process in the conditions of bleeding, we have developed organ-preserving operations such as the extraterritization of the ulcer, followed by Tanner-Kennedy plastics. Long-term results according to A.N. Visick-Komorovsky: excellent (no complaints) - 77.5%; good (minor dyspepsia, which is detected only by detailed questioning and corrected by diet) - 13.5%; satisfactory (there are symptoms that cause discomfort) - 5.6%; unsatisfactory (recurrence of the disease, change of profession, disability) - 3.4%. Conclusions. Organ-preserving and organ-sparing approach in reconstructive surgery is an essential means of preventing diseases of the operated stomach. Organ-preserving and organ-sparing operations allow to preserve the pacemaker regulation of the stomach and duodenum, which in the long run creates conditions for the prevention of dysmotorics of the pyloro-duodenal area.