Thesis for scientific degree of Candidate of Medical Sciences in specialty 14.01.03 - surgery. - National Medical University named after O.O.Bogomolets, Kiev, 2010. The thesis is devoted to solving the actual problem - improving the results of surgical treatment of complicated juxtapapillary duodenal ulcers (JDU) by developing modified classification of JPU, rational surgical tactics and new methods of surgical treatment. We analyzed the treatment results of 270 patients with complicated postbulbar duodenal ulcers (PDU) and JDU. 220 - PDU and 50 - JDU. The analysis of recent and late results of surgical treatment performed, including results analysis of 19 reimplantations of bile papilla (BP). Classification of complicated JDU was developed, which includes 6 classes (depending on the location relatively to BP and the level of BP involvement in the ulcerative process): I - suprapapillary ulcer (50% of all JDU), II - parapapillary (14%), III - papillary (12% ), IV - giant papillary (16%), V - infrapapillary (4%), VI - counterpapillary (mirror) ulcer (4%), which is the basis for selecting the method of surgical treatment. An algorithm of surgical tactics in bleeding JDU and PDU was developed. The methods of surgical treatment in complicated JDU based on classification were developed, both based on organ-preserving vagotomy and methods with reimplantation of BP in the duodenum or jejunum with external transpapillary drainage of choledochus (TPDC) in combination with vagotomy and antrumectomy. An algorithm for choosing one or another method of operation, depending on the classification of DJU, was developed. It was possible to reduce the incidence of postoperative complications during surgery for complicated JDU from 66,6% (I period) to 39% (II period) (p = 0.25), postoperative mortality from 33.3% (I period) to 14,6% (period II) (in 2,3 times, p = 0.398) and to find that the application of new techniques of reimplantation of BP at JDU not led to a deterioration in long-term results compared to surgical treatment of complicated PDU (analysis according to the scales Visick, SF-36 and GSRS). Keywords: surgical treatment, postbulbar duodenal ulcer, juxtapapillary duodenal ulcer, bile papilla, reimplantation.
