SELECTIVE PROXIMAL VAGOTOMY AND DUODENOPLASTY IN SURGERY OF ULCEROUS CICATRICIAL DUODENAL STENOSIS

Abstract

Aim. To study the usage of duodenoplasty and traditional drainage surgery in a combination with selective proximal vagotomy for ulcerous cicatricial duodenal stenosis. Materials and methods. Analysis of the common experience treating 150 patients with ulcerous cicatricial duodenal stenosis, which in addition to selective proximal vagotomy for the restoration of the duodenum passage received duodenoplasty (90 patients) and traditional drainage operation. The age of patients ranged from 16 to 67 years. 31 (20,6%) patients had compensated stenosis, 74 (49,3%) patients had sub-compensated and 45(30,1%) patients had decompensated duodenal stenosis. To find out the requirements for the selective proximal vagotomy, secretory test and examination of the stomach contractile ability with cerukal were conducted. Results and discussion. Intraoperational revision of the pyloric-duodenal segment allows defining the requirements and type of the pyloric preserving operation. From the position of the gastro-duodenal complex function restoration, duodenoplasty and stomach drainage operations are not equivalent Duodenoplasty restores the normal anatomy of the duodenum and preserves pylorus and creates optimal conditions for full rehabilitation of lost digestive functions. Conclusion. Selective proximal vagotomy is the most rational approach in a treatment of ulcer disease complicated by duodenal stenosis, which preserves the function of the pylorus and restores normal morphofunctional relations in the gastro-duodenal complex.