Surgical Treatment Of Peptic Ulcer Research Articles

Минуле, сучасне та майбутнє хірургічного лікування виразкової хвороби (50-річний досвід інституту)

У статті наведені дані літератури та результати власних досліджень авторів щодо розвитку хірургії виразкової хвороби в історичному аспекті. Показано, що еволюція знань про етіопатогенез виразкової хвороби впливала на розвиток методів хірургічних втручань при виразковій хворобі. Виділено основні періоди розвитку хірургії виразкової хвороби: перший період (1842–1881 рр.) — час зародження шлункової хірургії; другий період (80–90-ті роки XIX століття) — час становлення шлункової хірургії як самостійної клінічної дисципліни; третій період (кінець XIX — 20-ті роки XX століття) — час розвитку хірургії виразкової хвороби, коли методом вибору хірургічного лікування була гастроентеростомія; четвертий період (30–60-ті рр. XX століття) — час виникнення патогенетичних принципів хірургії виразкової хвороби, коли методом вибору служила резекція шлунка; п’ятий, останній період (із 70-х років XX століття і до сьогодні) — час підбивання підсумків 150-річної історії хірургії виразкової хвороби, коли лікарі схиляються до консервативного лікування цієї складної патології, а хірургічне втручання при виразковій хворобі направлене тільки на корекцію її ускладнень без руйнування органів травлення. Історичний досвід лікарів, які пройшли тернистим шляхом надій і розчарувань у пошуках оптимального підходу до хірургічного лікування виразкової хвороби, допоможе хірургам, терапевтам, морфологам та фізіологам у майбутньому.

КЛИНИЧЕСКИЙ СЛУЧАЙ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ПЕПТИЧЕСКОЙ ЯЗВЫ ГАСТРОЭНТЕРОАНАСТОМОЗА

In the article a clinical case of surgical treatment of peptic ulcer of gastroenteroanastomosis complicated with perforation and gastrointestinal bleeding, is described. The patient was observed with the diagnosis: cholelithiasis, chronic calculous cholecystitis, for which planned laparoscopic cholecystectomy with draining of the abdominal cavity was performed. According to the discharge record, the operation ran without peculiarities. Later the patient was rehospitalized with complaints of weakness, nausea, vomiting, pain in the upper parts of the abdomen; he was diagnosed with ulcer of gastroenteroanastomosis and continuing bleeding that were indications for the surgical intervention for life-saving indications. From the patient words, a part of the stomach was resected more than 20 years before for gastric ulcer. Until the latest time, the patient felt satisfactory, but within 6 months pain in the abdomen reappeared, however, on examination cholelithiasis was identified, and the pain syndrome was attributed to this pathology. Assumably, after the first operation performed in 1995, a complication developed in the early postoperative period in the form of obstruction of gastroenteroanastomosis (anastomositis?), and additional gastroenteroanastomosis was applied. Conclusion. Peptic ulcer of anastomosis is an actual problem of the gastric surgery which may not only appear long time after the operation, but may give the same complications as «essential» peptic ulcer, and really threaten the life of patients. It should be noted that in some cases the intraoperative picture, experience and sensations of a surgeon play a decisive role in the diagnosis of surgical pathology even if they differ from the data of additional methods of examination.

Alexander Nikolaevich BAKULEV - Soviet surgeon-scientist, the founder of cardiovascular surgery in the USSR (to the 130th of birthday)

Alexander Bakulev was born in the village Nebankovskaya Vyatka province. He studied first at the parish school, and then at the Vyatka theological Seminary. In 1911 he entered the medical faculty of Saratov University. In 1918, he passed the exams for a doctor's degree ahead of schedule and remained in the hospital surgery clinic of the University. In 1926 A. N. Bakulev entered the residency at the Department of surgery of the 2nd Moscow medical Institute. In 1928 he successfully defended his thesis and was sent for a one-year internship in Germany. For the first time in the domestic practice, he proposed the introduction of radiopaque substances in the brain tissue, a method of ureteral transplantation, improved methods of x-ray examination of vessels, kidneys and ureters, developed methods of plastic esophagus (1935), surgery on the biliary tract, methods of surgical treatment of peptic ulcer, for the first time in the world surgically eliminated the fixation of the heart muscle to the heart bag with pericarditis, developed new methods of treatment of brain abscesses. A. N. Bakulev is considered a pioneer of intubation anesthesia in the USSR, the founder of thoracic and radical pulmonary surgery. He performed a successful lobectomy for chronic abscess (1938) and lung actinomycosis (1939). In 1943 A. N. Bakulev became head of the Department. During the great Patriotic war A. N. Bakulev - front, and then chief surgeon of the evacuation hospitals of Moscow, head of the surgical Department of the hospital medical and sanitary Department of the Kremlin. He successfully removed a lung from a patient with chronic suppurative process (1945), for the first time carried out a successful operation in nezaradene known to inhibit the Bayou (1948), have developed a method comissurotomy. In 1949, A. N. Bakulev was awarded the Stalin prize (1949). He was the first to impose an anastomosis between the superior Vena cava and pulmonary artery, performed surgery for aneurysm of the thoracic aorta, created a technology of heart operations in hypothermia, for the first time in the world he began to operate on children suffering from congenital heart defects. In 1955 on the initiative of A. N. Bakuleva was established Institute of thoracic surgery (now the Institute of cardiovascular surgery. A. N. Bakuleva), the first Director of which he became. Among his developments can be noted the method of electrocardio-stimulation, intended for the treatment of heart rhythm disorders, a method of plasty of coronary vessels in acute myocardial infarction. In the mid-fifties A. N. Bakulev lays the foundations of shunting operations on the vessels of the heart. In 1957 he was awarded the Lenin prize. In 1959 A. N. Bakulev performed a successful operation for valvular stenosis of the pulmonary artery. In 1958, the scientist was elected a full member of the USSR Academy of Sciences. From 1953 to 1960 President of the USSR Academy of Sciences. A. N. Bakulev was awarded three orders of Lenin, the order of the red banner of Labor and the red Star, was awarded the highest international award of surgeons the award "Golden scalpel". On March 31, 1967, Alexander Bakulev died suddenly from cardiac arrest and was buried at Novodevichy cemetery. In memory of Alexander Nikolaevich in 2005, a documentary film "the Key to the heart" was shot in front of the Institute of cardiovascular surgery named after A. N. Bakulev monument to the scientist, and the building a plaque.

Current state of elective surgery for peptic ulcer

To analyze the current state of elective surgery for peptic ulcer and to assess its significance for improving the results of treatment of this disease. The analysis included elective procedures for peptic ulcer performed in the surgical department of Tula Regional Clinical Hospital in the period from 2011 to 2015. These data were compared with those for the period 1996-2000 in order to objectively identify current changes in surgery for peptic ulcer. The interval between both periods was 10 years. The main group consisted of 47 patients with peptic ulcer who underwent surgery in 2011-2015. The control group included 254 patients who underwent similar procedures in 1996-2000. Annual number of elective procedures for peptic ulcer decreased 5 times. There was advanced mean age in the main group, 29.8% of patients in the main group were older than 60 years, in the control group - 23%. Male/female ratio in the main group was 1:1, in the control group - 5:1. Prolonged ulcer history was observed in 10.6% of patients of the main group and 3.2% - in the control group. At the end of the last century, the greatest number of scheduled operations was performed for duodenal ulcer, now - for stomach ulcer. There was increased incidence of surgery for post-resection gastric syndrome (17 and 4.8% in both groups, respectively). We noted similar indications for elective surgical treatment of peptic ulcer in both groups. However, the negative feature of current period is significant augmentation of patients with decompensated pyloroduodenal stenosis. The structure of elective operations in 2011-2015 was characterized by significant proportion of decompensated complications of peptic ulcer as a result of prolonged medication. Prolonged postoperative hospital-stay and increased postoperative mortality were noted in the main group. Reduced number of elective procedures for peptic ulcer is associated with changed structure of patients undergoing surgery. Unreasonable prolonged medication aggravates patient state and adversely affects the results of surgical treatment. The current state of elective surgery for peptic ulcer does not correspond to the objective to improve the results of treatment of this disease.

Отдаленные результаты хирургического лечения язвенной болезни желудка и двенадцатиперстной кишки, осложненной перфорацией

The aim of the study was to investigate the effect of various methods of surgical treatment of peptic ulcer complicated by perforation on the quality of life. A comparative analysis of the influence of different surgical treatment in 118 patients with a perforated ulcer on the quality of life was carried out. Patients were divided into 4 groups: in the first group, ulcer excision was performed, in the second one - suturing, in the third one - stomach resection according to a modification of Billroth I, and in the fourth one - according to Billroth II. The best quality of life is enjoyed by patients who have undergone ulcer excision. The Billroth I stomach resection ranks second with respect to the influence on the life quality. The worst long-term results are obtained by suturing an ulcer and the Billroth II gastric resection.

Study of anatomical variations of anterior nerve of Latarjet and its clinical significance - A cadaveric study

Background: Highly selective or proximal gastric vagotomy is one of the definitive treatment for gastric ulcers. The results of this operation in comparison to truncal vagotomy is well appreciated by the surgeons. On the contrary incomplete and inadequate performance of this procedure results in recurrence of ulcer, post vagotomy diarrhoea and dumping syndrome. Knowledge about the normal and abnormal patterns of the anterior and posterior gastric nerves is imperative to the surgeons performing highly selective vagotomy. Most studies of this region have been performed on western population and the perspective of truncal and highly selective vagotomy is based on western literature only. However Indian studies regarding this one, are only few and far in-between. Aims & Objective: To study the variations of anterior of Latarjet & its implication in surgical treatment of peptic ulcer. Materials and Methods: This nature of study on Indian population in this part of the country is an initiative. 55 stomach specimens were utilized for the study. The present study was divided in to 3 parts: (i) Cadaveric specimens – 12 in numbers; (ii) Autopsy specimens – 40 in numbers; and (iii) Foetal Specimens – 3 in number. The anterior gastric nerve was dissected out from the level of commencement to the level of termination by dissection method. The branching pattern, plexus formation and crow’s foot appearance at the level of termination of anterior gastric nerve were studied. Results of present study were statically analyzed & compared with the findings of previous research workers. Results: The study of pattern of the anterior nerve of Latarjet in the present study showed wide variations in terms of branching pattern, plexus formation and crow’s foot appearance. Conclusion: The discussion emphasises the most important anatomical details relevant to the achievement of adequate highly selective vagotomy. Knowledge of these variations is of great importance for the surgeons performing highly selective vagotomy to achieve better results.

Risk of suicide among operated and non-operated patients hospitalised for peptic ulcers

Background:Some small studies have reported high risk of suicide after surgical treatment for peptic ulcer. The aim of the present study was to explore the risk of suicide in hospitalised...

Time Trends of Ulcer Mortality in Europe

The aim of the present study was to follow the time trends of ulcer disease in a representative sample of European countries and assess whether the most recent behavior of peptic ulcer still fits the overall pattern governed by an underlying birth-cohort phenomenon. Mortality data from 6 countries between 1921 and 2004 were analyzed, including Denmark, France, Germany, The Netherlands, Spain, and Switzerland. The age-specific death rates of gastric and duodenal ulcers from each individual country were plotted as period-age and cohort-age contours. The data from the past 50-80 years show striking similarities among the 6 European countries. In all countries alike, the risk of dying from gastric and duodenal ulcer increased among consecutive generations born during the second half of the 19th century until shortly before the turn of the century, and then decreased in all subsequent generations. The time trends of gastric ulcer preceded those of duodenal ulcer by 10-30 years. The increase in nonsteroidal anti-inflammatory drug consumption or introduction of potent antisecretory medications have not affected the long-term downward trends of ulcer mortality. The birth-cohort pattern has continued to influence the temporal variations of peptic ulcer until most recently. The unique shape of the birth-cohort patterns of gastric and duodenal ulcers and their identical appearance in countries with different health care systems and varying political and socioeconomic histories reflect the overriding influence of Helicobacter pylori infection.

The surgical treatment of peptic ulcer. A 15-year review.

Abstract A 15-year retrospective study of 713 patients having surgical treatment for peptic ulcer was carried out. A comparison of gastrectomy with vagotomy and drainage was made. The ways in which other factors may affect the outcome were also studied. The results are discussed and some conclusions drawn.

THE SURGICAL TREATMENT OF PEPTIC ULCER.

THE SURGICAL TREATMENT OF PEPTIC ULCER.

Surgical Treatment Of Peptic Ulcer

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Partial gastrectomy and mineral metabolism: effects on gastrin-calcitonin release

Bone mineral metablism was studied in 20 male patients, between 8 and 18 years, after surgical treatment for peptic ulcer (ten Billroth 1 and ten Billroth 2 gastrectomies) and in 16 sex- and aged-matched healthy controls. The bone mineral content was statistically reduced only in the Billroth 2 group. Serum 25(OH)D was lower in all patients, but fractional calcium absorption was similar to the control value. This may be due to increases in 1,25(OH) 2D and parathyroid activity (particularly in Billroth 2). Serum osteocalcin levels and hydroxyproline excretion were higher than in the controls. A positive linear correlation emerged not only between serum 1,25(OH) 2D and PTH levels but also between each of these and serum osteocalcin and urine hydroxyproline. Both PTH and calcitriol were inversely correlated with the bone mineral mass in Billroth 2, confirming a trend observed in Billroth 1. Although calcitonin values were normal, basal gastrin levels were severely impaired in all patients. In response to a mixed meal, increases in gastrin and calcitonin were significantly lower than in the controls. The calcitonin response to intravenous calcium and pentagastrin infusion was not significantly different to the controls. The percentage increase in gastrin and calcitonin responses to oral calcium correlated positively with the reduction in bone mineral content only in the Billroth 2 group, suggesting a reduction in calcitonin release may contribute to gastric surgery osteopenia in these patients.

Surgical treatment of peptic ulcer

Surgical treatment of peptic ulcer

Peptic Ulcer in the British Army: A Comparison of Outcome following Medical and Early or Late Surgical Treatment in the Pre-Cimetidine Era

It is difficult to define the best treatment for peptic ulcer because the effectiveness of treatment may be measured in many different ways, each affecting the Therapeutic objectives might include relief of symptoms, healing of ulcer, prevention of complications, prevention of relapses, and social or occu­ pational rehabilitation. Despite the multiplicity of objectives, most clinicians will have some concept of what constitutes an acceptable or an unacceptable of treatment for each patient. In the British Army, compared with civilian life, certain criteria require to be more heavily emphasised than others in considering outcome. Fitness to perform his duties emoiently and continuously is a sine qua non of a serviceman's employment. If a medical defect exists which actually or potentially restricts his employalbiHty he must be either invalided from the service or medically down­ graded; the latter may render him ineligible for consideration for promotion and thereby ruin his career. Because he is expensive to train a new recruit will be more readily invalided from the service than a mature, fully-tl'a'ined specialist, the loss of whom would be a more catastrophic event both for the service and for the individual. Although only a small proportion of servicemen with peptic ulcer are invalided, this disease remains the single most common cause of invaliding from the British Army (Statistical Report on the Health of the Army, 1975). This fact is well known to service olinicians but despite this there is no unanimity as to the best approach to management, nor to the difficult qu~tion of the degree of medical downgrading or restriction upon employability indicated for peptic ulcer patients in various circumstances. Any data which throw light upon this problem are useful. This paper presents a retrospective analysis of the outcome of medical versus surgical treatment for peptic ulcer in a cohort of serving personnel in the pre-Cimetidine era. Patients and methods All personnel serving in the British Army who were first diagnosed during the year 1965,as having a peptic ulcer were identified and their medical documents examined. Reports of all out-patient attendances, hospital admissions,

Letter: Surgical treatment of peptic ulcer.

Letter: Surgical treatment of peptic ulcer.

Surgical Therapy of Chronic Peptic Ulcer: Preoperative Assessment, Choice of Operations, and Consequences

Gastric secretory testing remains an integral part of the surgical treatment of peptic ulcer which, taken in conjunction with the patient as a whole, will indicate a preference for a certain treatment plan. The authors prefer hemigastrectomy and vagotomy for most cases of duodenal ulcer.

Changes in the surgical treatment of peptic ulcer.

A previous article reported 300 patients treated for benign ulcer disease by gastric resection at Burbank Hospital from 1952 through 1962. The present article studies 225 patients treated surgically during the years 1963 through 1971 and assesses the impact of changes in surgical management. We have found favorable, though not statistically significant, trends in mortality and morbidity, especially in patients with duodenal ulcers. The patient mortality fell from 6.3% to 4.4% overall, from 7.2% to 4.4% for duodenal ulcer, and from 3.3% to 1.2% for elective operations. In investigating reasons for the improvement, it was found that gastric resection remains the principal mode of treatment, but there is an increase in other procedures combined with vagotomy, especially in difficult situations. More liberal use of duodenostomy tubes seems to be another reason for improved results.

Indication for surgical treatment of peptic ulcer

Indication for surgical treatment of peptic ulcer

Surgical treatment of peptic ulcer

Surgical treatment of peptic ulcer

Surgical treatment of peptic ulcer

One hundred sixty-eight operations carried out as definitive treatment for peptic ulcer were analyzed. Pyloroplasty and vagotomy are currently favored as the operation of choice, based on the low immediate complication rate and the fact that they offer the promise of permanent relief of ulcer symptoms in most patients.