Tkach S. Surgical treatment of peptic pyloroduodenal stenosis with the prediction of ulcerative reflux esophagitis.

Dissertation is dedicated to improving of the results of surgical treatment of patients with ulcerative pyloroduodenal stenosis by reducing of mortality and postoperative complications by means of imporoved the surgical tactics and methods of surgical treatment. Currently, one of the main methods of surgical treatment and its complications is selective proximal vagotomy. SPV technique involves significant anatomical damage in the area of the esophagogastric junction, which reinforces the existing violations of the cardia valve function and contributes to the development of postoperative reflux esophagitis. Reflux esophagitisa is major cause of reducing of the quality of patients life of and poor results of these operations , its frequency after distal gastrectomy performed without correction of the cardia, reaches 20-50%. Choice of antireflux surgery, which complements the main intervention for peptic ulcer disease, is complex and not completely solved task due to the large number of technical options for the correction of the cardia. In recent years significantly changed the appearance of the theoretical foundations of reflux esophagitis, a lot of questions surgical treatment has undergone,were introduced new methods. The results of a comprehensive examination and surgical treatment of 146 patients with duodenal ulcer complicated by pyloroduodenal stenosis,in which selective proximal vagotomy in combination with an antireflux operations in the cardia was applied. The comparison group consisted of 132 patients with uncomplicated ulcer and 58 healthy individuals. There were 109 (74.6%)men, - 37 (25.4%) women with the age 20 to 70 years, mean age - 43 ± 2,7 years. Depending on the method of antireflux surgery at the cardia, the patients were divided into three groups.In the first group, consisting of 25 patients Nissen fundoplication in the classic version was performed. Fundoesofagocrurupexia wos perfomed in patients of the second group, consisting of 43 persons.For the third group of 78 patients modified fundoplication and ezofagofrenofundopeksiya were prrfomed as a antireflux surgery of the cardia. Long-term results of correction of valvular function of the cardia in terms of 1 year to 5 years were studied in 126 (86.3%) of patients wto had unergone NF - 25 FECP - 41, F + FECP - 60 patients. Efficiency of operations was evaluated on base of a comprehensive clinical and instrumental examination. Among the 125 studied patients, in long-term follow up endoscopic signs of RE were found in 10 (8%) patients. The frequency of postoperative RE was the highest after FEKP (12.2%) and lowest after F + esofagofrenofundopexia of our modification (5%). Were registered excellent and good results in 110 (88.8%) patients,in 5 (4%) - satisfactory, 10 - unsatisfactory. Thus, the main cause of failure of the locking function of the cardia in patients with ulcerative PDS is a violation of the motor-evacuation function of the stomach. SPV + DS(drainage of the stomack) interrupts basic pathogenetic links of failure of the cardia, esofagofrenofundopexia is the most secure and technically simple antireflux operation thet reliably corrects failure of cerdia and prevents the development of RE.