Treatment of patients with pyloroduodenal ulcers complicated by stenosis

Gastric resection for duodenal ulcers, which has been the operation of choice for the past decades, cannot be considered perfect. Postoperative mortality in this disease is 4-5% [3, 5], and in patients with pyloroduodenal stenosis — 2,5—11,5% [1, 8]. In addition, almost 30% of the operated patients have post-resection complications, primarily dumping syndrome. Disability is also high: during the first year after surgery, the number of disabled people in groups II—III reaches almost 50% [2, 5]. That is why in recent years, various organ-preserving and organ-sparing operations have been developed for duodenal ulcer. Of these, preference is given to selective proximal vagotomy. In the presence of stenosis, this operation has to be combined with various gastric drainage interventions. Our country has already accumulated a lot of experience in conducting such combined operations [3-6]. More physiological in comparison with gastric resection, they still have some disadvantages. The main one, perhaps, is the non-proportional and rapid flow of gastric contents into the duodenum, as a result of which some patients may develop dumping syndrome, and the constant yawning of the outlet part of the stomach after pyloroplasty can lead to duodenogastric reflux with the subsequent development of a rather severe and difficult-to-treat complication-reflux gastritis [11, 12]. Our observations also confirm this. Of the 94 patients who underwent drainage operations, 6 had dumping syndrome, and 23 had reflux gastritis. We have a particularly negative attitude towards cytoplasty. After it, both dumping syndrome, reflux gastritis, and restenosis can develop, which one of our patients had.