Laparoscopic surgery of perforated duodenal and gastric ulcers

During the period of 13 months, the authors have operated on seven patients with perforated gastroduodenal ulcers. All surgeries were completely performed by the laparoscopic method. The laparoscopic suture of perforated ulcers was performed with lavage and only in one case it involved omentoplasty. The healing process was free of any complications in all patients. The advantage of laparoscopic operations of perforated ulcers resides in fast convalescence and in the fast restoration of working abilities. This method is appropriate in cases when the surgeon performing laparoscopic surgeries has sufficient experience in coincidence with the treatment of perforated ulcers.     

The course of the reparative process in patients with gastric and duodenal peptic ulcers (a clinico-statistical study)

Clinico-statistical evaluation of reparative process in 332 gastric ulcer and 294 duodenal ulcer patients revealed factors of objective value to its course. In order of significance the factors rank as follows: area of ulcer, localization, combination with certain mucosal erosions, total fasting acidity, free fasting hydrochloric acid, basal gastric secretion, cardial function, duodenogastric reflux, sex, age, number of cigarettes smoked daily. When studying treatment effects on regeneration in ulcer patients in is necessary to take into consideration basal clinico-endoscopic parameters.     

History of perforated duodenal and gastric ulcers

Perforated peptic ulcer as a disease entity has been known since 167 BC. Surgical and nonsurgical treatment strategies for perforated peptic ulcer disease were not developed until the latter half of the nineteenth century. The history of the gradual evolution of the various forms of treatment adopted for the conditions over the last century and a half is described.     

Therapeutic indications in hemorrhaging duodenal and gastric ulcers

Ulcer complications including bleeding and perforation were increasingly observed during the last decade due to the greater life expectancy and the increased NSAID consumption. The unchanging mortality rate, which has been around 6-10% for several decades, could be explained by the fact that age and the prevalence of concurrent illness are important predictors of death. Rebleeding which is also an independent prognostic factor can be predicted by the presence of hypovolemic shock and of endoscopic stigmata such as active bleeding or a visible vessel. Endoscopic hemostatic therapy, specially injection therapy which is the most widely used method, has become the treatment of choice. It has been proven to significantly reduce rates of further bleeding, surgery and mortality. Surgical intervention is indicated in cases of immediate or secondary failure of endoscopic therapy (20%) and should not be delayed in high-risk patients. Once hemostasis has been achieved therapeutic goals are to heal the ulcer and to prevent the occurrence of further complications including bleeding and also perforation.     

The significance of gastric helicobacteriosis in the genesis hemorrhage from duodenal peptic ulcer

Based on a comprehensive analysis of findings from examination and surgical treatment of 196 patients with bleeding pyloroduodenal ulcers, it was found out that patients with concurrent helicobacteriosis of the stomach are prone to more unfavourable course of their illness, which fact is evidenced by a greater loss of blood and higher risk for bleeding recurrences. A classification is proposed by the authors, taking advantage of the data from endoscopic, microscopic and immunoenzymatic techniques, with the purpose of providing an assessment of degree of severity of helicobacteriosis of the stomach.     

An etiologic approach to management of duodenal and gastric ulcers

The dynamics of intestinal absorption, blood concentration and distribution of thiamin, biotin, nicotinate, riboflavin, pantothenate, various folates (folic acid, folinic acid, pteroyltriglutamate), vitamins A, E, C, B12, and B6 were monitored in 12 patients by multiple simultaneous sampling of blood obtained by combined catheterization of portal vein, hepatic vein, and femoral artery after vitamin ingestion. All water-soluble vitamins proved elevated after vitamin ingestion principally in portal blood within 10 minutes as compared with hepatic and femoral blood. Elevated vitamin levels in portal blood--compared to hepatic and femoral blood--remained high even after 120 min. indicating that absorption from the gut was still progressing. In contrast, ingestion of the fat-soluble vitamins A and E evoked no elevated vitamin activity in portal blood. Within 10 min. after vitamin ingestion, all folates were converted into reduced and methylated 5-methyltetrahydrofolate (5-CH3THF) on passage through the gut. At this time, portal blood elevation of 5-CH3THF persisted before its elevation in hepatic or femoral blood. Presumably, the elevation was not due to the flushing of stored 5-CH5THF from tissues but rather of folate conversion to 5-CH3THF upon gut passage. The significance of these findings is discussed.     

The evaluation of pathogenic factors in duodenal ulcers

There were examined 90 patients with severe course of duodenal ulcer disease. In 83% of patients the atropinedependent reaction of acid production was noted, giving evidence the dominant influence of neural regulation on gastric secretion, in 17%--atropineresistant reaction, giving evidence the hormonal mechanism of regulation.     

The etiological and pathogenetic characteristics of duodenal peptic ulcer in adolescents

Studied by endoscopy were 100 adolescents with diagnosed duodenal ulcer, as were 100 essentially healthy subjects and 90 ones of the same age presenting with primary chronic gastroduodenitis together with 60 adults who had duodenal ulcer. The following items were etiologic risk factors for duodenal ulcer, if combined, in the above adolescent series: Frequent episodes nervous of tension, hereditary predisposition and helicobacteriosis. In juveniles with duodenal ulcer, secretion and motility of the stomach appeared to be subjected to changes to a higher degree than it was in adult subjects with duodenal ulcer, while functions of the psychovegetative and immune systems were found to be less changeable in the former. In adolescents presenting with duodenal ulcer and primary chronic gastroduodenitis, the etiologic risk factors and pathogenetic changes were found out to be identical.     

Total duodenal diversion in the treatment of complex peptic esophagitis

AIMS OF THE STUDY: The aims of this study was to report the results of total duodenal diversion in patients with complex peptic esophagitis (peptic stenosis, acquired short esophagus, columnar lined esophagus, previous surgery). PATIENTS-METHODS: Total duodenal diversion has been performed in 107 patients with complex peptic esophagitis. The standard procedure--including a troncular vagotomy, an antrectomy and a 70 cm Roux-en-Y gastro-jejunostomy--was used in 68 cases (64%). Technical adjustments were necessary in the 39 others patients. RESULTS: Two patients (1.8%) died postoperatively. Permanent healing of esophagitis was observed within 3 months in 88% of patients. Esophagitis healed in all patients operated with the standard technique. Three hours postprandial pH-monitoring was normal postoperatively in 92% of patients. Four anastomotic ulcers occurred in patients who did not have vagotomy. Among patients with columnar lined esophagus, one complete and six partial regressions were observed; no malignant degeneration was observed with a 210-patient-year follow-up. Among the 39 peptic stenoses, all except one (2.6%) resolved. Functional disorders occurred in 27% of patients within the first postoperative months; these disorders persisted in 14% of patients (Visick III or IV) after 3 years. The main disorders (dumping syndrome, anastomotic ulcer, diarrhea) were observed when a two-thirds distal gastrectomy has been performed to avoid the dangerous completion of vagotomy after a previous Heller's myotomy. CONCLUSION: These results suggest that total duodenal diversion is a suitable treatment of complex peptic esophagitis.     

The use of pylorus-sparing operations in treating duodenal peptic ulcer complicated by stenosis

Based on an analysis of immediate (388 patients) and long-term (259 patients) results of surgical treatment of ulcer disease of the duodenum complicated by stenosis the authors made a conclusion that selective proximal vagotomy in combination with dissection of the ulcer substrate (the stenosis area) without injuries of the pyloric constrictor is the operation of choice in treatment of ulcerous duodenal stenosis resulting in less lethality (0.52%), in practical exclusion of the development of functional disorders and impaired nutrition of the patients.     

Lysozyme concentration in the gastric juice in peptic ulcer

Lysozyme concentration in the gastric juice of 34 patients with peptic ulcer and 10 practically healthy persons was studied. In the patients with peptic ulcer the lysozyme levels in the gastric juice were found to be lower. A significant decrease in the lysozyme concentration was observed in the patients suffering from peptic ulcer for more than 2 years. During the first months of the disease increased levels of lysozyme were recorded. Relationship between the lysozyme concentration in the gastric juice and the acidity of the gastric contents was shown. Decreased concentrations of lysozyme were more pronounced in the patients with increased levels of hydrochloric acid.