The dissertation is dedicated to the solution of the actual scientific task of improvement results surgical treatment patients on gastroduodenal ulcer with multiple combined complications by developments and implementation medical - tactical algorithm in and application rational methods operational interventions.
Currently in the world observed high gastroduodenal disease ulcer (10-15% of adults population) while saving enough high frequency her complicated course
(perforation 10-20%, bleeding 20-30%, stenosis 11-15%, penetration 16-34%) (Young PJ, Bagshaw SM, Forbes AB, Nichol AD, Wright SE, et al. 2020) [128].
Hope that rely on implementation at the end of the 20th century new one’s principles of drug treatment (H2-blockers, inhibitors proton pump and eradication therapy) with positive urease tests that encouraged gastroenterologists, did not decrease quantity peptic ulcer patients. As shown later observation, the number of patients with gastroduodenal ulcers has the tendency to increase with a steady curability only 35-40% of cases. Strategy mainly conservative treatment patients with gastroduodenal disease an ulcer contributed to stable decreasing trends quantity planned operational interventions by 2.0-2.5 times and an increase in the number of patients with complicated forms of ulcers (perforation, bleeding, stenosis, penetration), which require operational help.
The problem of surgical treatment of complicated gastroduodenal ulcers remains an actual problem, regardless of the introduction of new schemes of antiulcer and antihelicobacter therapy (Gisbert J.P., 2012) [68]. The frequency of complications of gastroduodenal ulcer now tends to decrease (Dunlap JJ , Patterson S. 2019) [64]. There is an increase in the percentage of patents when multiple (two, three and four) simultaneous complications are combined (Clinch D, Damaskos D, Di Marzo F, Di Saverio S. 2021) [53], postoperative mortality rates are very high and range from 57% to 75% (Malmi H , Kautiainen H , Virta LJ , Farkkila M.A. 2016) [111]. Information regarding tactical approaches and responses to surgical treatment of this category of patients with a combination of three (bleeding, penetration and stenosis; bleeding, penetration and perforation; bleeding, perforation and stenosis; perforation, penetration and stenosis) and four complications (bleeding, perforation, penetration and stenosis) can rarely be found in the available literature.
Surgical elimination of only complications sometimes turns out to be inefficient due to insufficient amount of adequate medical treatment in the postoperative period, which in most cases is inaccessible to patients due to its high cost. For this reason, surgeons believe that implementation primarily radical surgical interventions is justified. All of the above indicates the need to review the tactics of treating patients with chronic gastroduodenal ulcer and to develop indications for the timeliness of surgical treatment by gastroenterologists together with endoscopists and surgeons, taking into account morphological changes in biopsies that confirm the chronicity of the process.
That is why the problem of improvement approach to surgery treatment combined complications gastroduodenal ulcers remains important and relevant.
