Buka G. Features of diagnostics and surgical treatment for the patients with the complicated recurrent postoperative gastroduodenal ulcers

The dissertation is devoted to optimize the treatment process for the patients with the complicated recurrent postoperative gastroduodenal ulcers (RPGDU). Based on in-depth study of pathophysiological changes of the operated stomach and duodenum, surgical policies and algorithm for the selection of surgical inter-vention in case of patients with RPGDU were developed, the existing methods were improved, the new original method of surgical treatment and postoperative rehabilitation for the patients with the complicated postoperative recurrent gastro-duodenal ulcers was developed. Four groups of causes of unsatisfactory results of the treatment of peptic ulcer, which led to the emergence of recurrent postoperative gastroduodenal ulcer, were determined. The expediency of using periods of arterial sympathectomy of the duodenum to correct its tonus was experimentally justified. The algorithm of choice of the surgical intervention was introduced at the practical level as it allowed to increase the number of organ saving reconstructive operations in case of patients with RPGDU after organ saving operations and resection of stomach in 2,9 and in 2,25 times resp. and to increase the number of organ saving operations in 2,3 times. The usage of the advanced surgical tactics in case of pa-tients with complicated RPGDU allowed to: increase the planned surgical activity in case of patients with RPGDU after organ saving operations and resection of stomach on 13,7% and 27,6%; reduce the postoperative mortality rates from 3,8% in the comparison group to 2,0% in the primary group; increase the number of ex-cellent distant results of the surgical treatment in case of patients in the primary group, relative to the comparison group in 1,4 times; reduce the number of unsatis-factory distant results in 1,5 times.