Ivanchov P. Surgical tactics in the bleeding recurrent peptic ulcers after vagotomies and stomach resection.

The dissertation is devoted to the problem of Bleeding recurrent peptic ulcers after different kinds of vagotomy with the drainage procedures on the stomach (282) and after resection of stomach (153). All patients were admitted emergency with the signs of hemorrhage. We studied and analyzed the conditions of their previous primary operations on peptic ulcer and live activity after surgical treatment. It has been established some clinical and endoscopic peculiarities of the recurrent peptic ulcers complicated by hemorrhage, severity and activity of the bleeding on the base of the laboratory tests and endoscopic findings, risk of the development early rebleeding in the different groups of patients. Methods of endoscopic procedures for hemostasis were used and results of their efficacy were compared. Three new methods of endoscopic treatment of bleeding recurrent peptic ulcers were proposed. Pathomorphological investigations of biopsy and operative materials of duodenum and stomach showed some specifically morphological changes in the region of peptic ulcers and layers of wall, which were depended upon the kind of previous operations. As a result of received experience the algorithm of the surgical tactics was worked out which included endoscopic monitoring and criteria for medical and surgical treatment. The offered algorithm has enabled to reduce surgery activity, emergency operations in 2,1 times and total as postoperative mortality from 2,5% and 5,5% to 0.