Efficacy of intravascular embolization in profuse hemorrhage from complicated duodenal ulcers

Objective. To estimate the efficacy of intravascular embolization in profuse hemorrhage from complicated duodenal ulcers. Materials and methods. Into the investigation 80 patients were included, operated for the profuse hemorrhage complication of duodenal ulcers, penetrating into pancreatic head. The patients were distributed into two groups: the control - 40 patients, in whom the standard methods of the hemorrhage arrest were applied, and the main - 40 patients, in whom the method elaborated was used. Results. In the main group in postoperative period the complications have had occur in 1 (2.5±0.2%) patients (p<0.001) only - the duodenal fistula development. There was verified, that the best results of hemostasis in hemorrhage from penetrating duodenal ulcers were obtained in the patients of the main group, in whom іntraoperative endovascular arrest of the hemorrhage together with the ulcer suturing was applied, because in 100% of patients of this group the definite hemostasis was achieved. Conclusion. The proposed method of intraoperative endovascular arrest of hemorrhage from penetrating duodenal ulcer guarantees a qualitative hemostasis, lowers the rate of the hemorrhage early recurrence and the need for relaparotomy performance, and raises the surgical treatment quality.

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Surgical treatment of complicated duodenal ulcers with different variants of their localization

Journal of Education, Health and Sport ◽

10.12775/jehs.2021.11.09.093 ◽

2021 ◽

Vol 11 (9) ◽

pp. 773-780

Author(s):

D. Maksymchuk ◽

V. Mamchych ◽

V. Maksymchuk

Keyword(s):

Duodenal Ulcer ◽

Surgical Treatment ◽

Gastrointestinal Bleeding ◽

Surgical Techniques ◽

Clinical Protocols ◽

Duodenal Ulcers ◽

The Third ◽

Alternative Method ◽

Pyloric Canal

Purpose: To analyze and highlight the most effective methods of surgical treatment of complicated duodenal ulcer (DU) depending on its location. Material and methods. 86 patients underwent surgery for complicated combined pyloroduodenal ulcers. All patients with signs of gastrointestinal bleeding and perforation were examined according to clinical protocols. Patients were operated on by various surgical techniques depending on the location of DU. Further the analysis of different methods of surgical treatment of the pathology under study at its various localizations was carried out. Results. It has been established that in complicated combined pyloroduodenal ulcers with localization in the pyloric canal antrumectomy is the method of priority. If duodenum ulcer is complicated by bleeding, excision with pyloroplasty is the method of priority. Suture ulceration with pyloroplasty can be considered as an alternative method of treatment. It has been verified that in complicated duodenal ulcers, exteriorization and suturing of the ulcer have the lowest efficiency. The most frequently used method of duodenal ulcers of any localization treatment was excision of the ulcer with pyloroplasty. 6 (41.8 ± 0.053%).patients had been operated on by this method. In the second place in terms of universality was ulcer’s suturing with pyloroplasty - 22 patients or (25.5 ± 0.047%). The third was the method of exteriorization and suturing of ulcers, which accounted for 10 patients (11.6 ± 0.034%).

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Gastric and 12 duodenal ulcer from a surgical point of view

Kazan medical journal ◽

10.17816/kazmj71715 ◽

1934 ◽

Vol 30 (2) ◽

pp. 261-276

Author(s):

N. V. Sokolov

Keyword(s):

Duodenal Ulcer ◽

Surgical Treatment ◽

Scientific Data ◽

Past Experience ◽

Point Of View ◽

Present Stage ◽

Duodenal Ulcers

To put the question of gastric and duodenal ulcer from the surgical point of view means to decide more or less definitely whether a gastric and duodenal ulcer at the present stage of our knowledge of this painful form can be treated surgically and what are the indications for surgical treatment; it means to decide the choice of this or that method of surgical treatment of gastric and duodenal ulcers, proceeding in this question based on past experience covered by modern scientific data.

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SURGICAL APPROACH IN CONCOMITANT COMPLICATIONS OF DUODENAL ULCER

Inter Collegas ◽

10.35339/ic.5.4.165-170 ◽

2018 ◽

Vol 5 (4) ◽

pp. 165-170

Author(s):

F. Nishanov ◽

B. Abdullajonov ◽

M. Nishanov ◽

J. Rustamov ◽

B. Ibragimov ◽

...

Keyword(s):

Duodenal Ulcer ◽

Surgical Treatment ◽

Surgical Approach ◽

Therapeutic Approach ◽

Gastric Resection ◽

Optimal Treatment ◽

Duodenal Ulcers ◽

Treatment Methods ◽

Specific Complication

SURGICAL APPROACH IN CONCOMITANT COMPLICATIONS OF DUODENAL ULCERNishanov F., Abdullajonov B., Nishanov M., Rustamov J., Ibragimov B., Mishenina E.Authors analyzed results of surgical treatment in 307 patients with concomitant complications of duodenal ulcer. Patients were divided into 2 groups according to the chosen diagnostic and therapeutic approach. The first group comprised 168 (54.7%) patients who underwent “traditional” gastric resection while the second group included 139 (45.3%) patients who underwent modifying variants of gastric resection.It was established that improvement of definite operation types and employment of optimal treatment methods can result in a decrease in frequency of early postoperative specific complication by 8.3% (from 15.5 to 7.2%, р<0.01), frequency of re-laparotomy by 4.3 (from 6.5 to 2.2%) and mortality by 2.2% (from 2.9 to 0.7%, р<0.05), and this gives a possibility to improve the results of surgical treatment of concomitant complications of duodenal ulcers in whole.Key words: duodenal ulcer, gastric resection, re-laparotomy, modification variants. РезюмеХІРУРГІЧНА ТАКТИКА ПРИ ПОЄДНАНИХ УСКЛАДНЕННЯХ ВИРАЗКОВОЇ ХВОРОБИ ДВАНАДЦЯТИПАЛОЇ КИШКИНішанов Ф., Абдуллажанов Б., Нішанов М.Ф, Рустамов Ж., Ібрагімов Б., Мішеніна К.Автори аналізують результатів хірургічного лікування 307 пацієнтів з поєднаними ускладненнями ВХДПК.Хворих в залежності від застосованої діагностичної та хірургічної тактики умовно поділили на 2 групи. Першу контрольну групу склали 168 (54,7%) пацієнтів,яким були виконані «традиційні» варіанти резекції шлунка, другу основну групу склали 139 (45,3%) пацієнтів,яким були виконані модифіковані варіанти резекції шлунка.Встановлено,щоудосконалення окремих технічніхприйомів операції та застосування оптимальних способів лікування ускладнень,дозволяють знизити частоту ранніх післяопераційних специфічних ускладнень на 8,3% (з 15,5 до 7,2%,р <0,01), частоту релапаротомій на 4,3 (з 6,5 до 2,2%) і летальних випадків на 2,2% (з 2,9 до 0,7%, р <0,05), тим самимсприяючи поліпшенню результатів хірургічного лікування поєднаних ускладнень дуоденальних виразок в цілому.Ключові слова: язвена хвороба дванадцятипалої кишки, резекція шлунку, релапаратомія, модифіковані варіанти. РезюмеХИРУРГИЧЕСКАЯ ТАКТИКА ПРИ СОЧЕТАННЫХ ОСЛОЖНЕНИЯХ ЯЗВ ДВЕНАДЦАТИПЕРСТНОЙ КИШКИНишанов Ф., Абдуллажанов Б., Нишанов М., Рустамов Ж., Ибрагимов Б., Мишенина Е.Авторы анализируют результатов хирургического лечения 307 пациентов с сочетанными осложнениями ЯБДПК. Больных в зависимости от примененной диагностической и хирургической тактики условно разделили на 2 группы. Первую контрольную группу составили 168 (54,7%) пациентов, которым были выполнены традиционные варианты резекции желудка, вторую основную группу составили 139 (45,3%) пациентов которые были выполнены модифицированные варианты резекции желудка.Установлено, что усовершенствованные отдельные технические приемы операции и применение оптимальных способов лечения возникших осложнений позволяют снизить частоту ранних послеоперационных специфичных осложнений на 8,3% (с 15,5 до 7,2% р<0,01), частоту релапаротомии на 4,3 (с 6,5 до 2,2%) и летальных исходов – на 2,2% (с 2,9 до 0,7%, р<0,05), тем самым способствуя улучшению результатов хирургического лечения сочетанных осложнений дуоденальных язв в целом.Ключевые слова:язвенная болезнь желудка, резекция желудка, релапаратомия, модифицированные варианты.

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What type of vagotomy for duodenal ulcer?

Drug and Therapeutics Bulletin ◽

10.1136/dtb.12.8.29 ◽

1974 ◽

Vol 12 (8) ◽

pp. 29-31

Keyword(s):

Duodenal Ulcer ◽

Surgical Treatment ◽

Gastric Acid ◽

Social Life ◽

Acid Output ◽

Partial Gastrectomy ◽

Duodenal Ulceration ◽

Gastric Acid Output ◽

Duodenal Ulcers

By convention, vagotomy means the division of all or part of the vagus in the abdomen. Gastric acid output falls by 50 – 70% after vagotomy, allowing duodenal ulcers to heal in most patients. Since its introduction in 1943 the operation has been much modified, and has largely replaced partial gastrectomy in the elective surgical treatment of uncomplicated chronic duodenal ulceration. In general, the need for operation is determined by the severity and duration of the symptoms, and the extent to which they interfere with the patient’s work and social life.

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Influence of perioperative intraarterial selective chemotherapy on terms of recurrent ductal adenocarcinoma of the pancreatic head after pancreaticoduodenectomy

Annaly khirurgicheskoy gepatologii = Annals of HPB surgery ◽

10.16931/1995-5464.2018314-22 ◽

2018 ◽

Vol 23 (3) ◽

pp. 14-22

Author(s):

A. V. Pavlovskiy ◽

V. E. Moiseenko ◽

S. A. Popov ◽

A. A. Polikarpov ◽

A. A. Statsenko ◽

...

Keyword(s):

Surgical Treatment ◽

Combined Treatment ◽

Pancreatic Head ◽

Celiac Trunk ◽

Progression Free Survival ◽

Regional Chemotherapy ◽

Main Group ◽

Ductal Adenocarcinoma ◽

Control Group ◽

Selective Chemotherapy

Aim. To analyze influence of perioperative intra-arterial selective chemotherapy on terms of recurrent ductal adenocarcinoma of pancreatic head after pancreaticoduodenectomy.Material and methods. 111 patients underwent combined treatment. Surgical stage included conventional pylorussparing pancreaticoduodenectomy in all groups. The main group consisted of 52 patients who received combined treatment: neoadjuvant chemoembolization with gemcitabine (400 mg/m2) and oxaliplatin (50 mg/m2), surgical treatment and 6 courses of regional chemotherapy – infusion of gemcitabine (800 mg/m2) and oxaliplatin (45 mg/m2) into celiac trunk in adjuvant mode. The control group was presented by 59 patients who underwent perioperative regional chemotherapy (neoadjuvant chemoembolization and adjuvant infusion of gemcitabine (800 mg/m2). Progression-free survival (PFS) and terms of recurrence were analyzed in all groups. In case of progression and recurrence we applied regional chemotherapy alone. Systemic chemotherapy was not used in the study.Results. Annual PFS in the main and the control groups was 80%. Three-year PFS in the main group was 37%, in the control group – 14% (p < 0.01). Five-year PFS was 11% in the main group and absent in the control group. Median survival was 26 months in the main group and 22.6 months in the control group. Overall annual, 2-year and 5-year survival in main group was 80%, 57% and 15%, respectively.Conclusion. Regional intra-arterial chemotherapy decreases incidence of recurrences and improves PFS after surgical treatment of pancreatic head adenocarcinoma.Further multi-center studies are necessary to assess the effectiveness of regional chemotherapy.

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LAPAROSCOPIC REPAIR OF PERFORATED DUODENAL ULCER PATCH VERSUS CONVENTIONAL SURGERY

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i1.600 ◽

2019 ◽

Vol 3 (1) ◽

Author(s):

Dr. Anil Kumar Saxena ◽

Dr. Devi Das Verma

Keyword(s):

Duodenal Ulcer ◽

Laparoscopic Repair ◽

Open Repair ◽

Wound Dehiscence ◽

Duodenal Perforation ◽

Perforated Duodenal Ulcer ◽

Conventional Surgery ◽

Duodenal Ulcers ◽

Duration Of Operation ◽

Repair Group

Introduction: For many surgeries for duodenal ulcer Laparoscopic repair has become gold standard for many elective procedures such as ant reflux procedures, laparoscopic cholecystectomy and in colorectal surgery. Although in the emergency setting such as in the management of perforated duodenal ulcer Laparoscopic repair has been slow and limited. Since 1990, for the treatment of perforated peptic ulcer Laparoscopic repair has been used which has been widely accepted as an effective method. Duodenal ulcer is defined as a peptic ulcer which develops in the first part of the small intestine called duodenum and usually present as a perforation of acute abdomen. In perforated duodenal symptoms as severe and sudden onset abdominal pain that is worse in right upper quadrant and epigastrium and usually followed by nausea and vomiting. In this situation there is rapid generalization of pain and in examination shows peritonitis with lack of bowel sounds. Aim: The main objective of this study is to evaluate outcome of laparoscopic surgery in comparison with conventional surgery. Material and methods: All the patients with clinically diagnosed with perforated duodenal ulcers presenting within 24 hours of symptoms and undergoing surgery were included during the study period. Total 50 patients were included with age group 15-65 years. All the patients with perforated duodenal ulcers were included which go through either conventional open or laparoscopic without omental patch repair. Result: Total 50 patients were included in these studies which were divided into two group with 25 patients in each group as laparoscopic duodenal perforation repair group and conventional open repair group. Mean duration of operation (in minutes) was 105.4±10.4 in laparoscopic duodenal perforation repair group whereas mean duration of operation (in minutes) was 67.3±8.6 in conventional open repair group. Mean duration of number of doses of analgesics required in laparoscopic group and conventional open group as 9.5±1.7 and 17.2± 3.1 respectively. Out of 25 patients in each group of laparoscopic duodenal perforation repair group and the conventional open repair group the outcome were noted with their post operative complication as shown in table no 5 below. In Post-operative complications 21(84%) patients in laparoscopic duodenal perforation repair group and 14(56%) patients in conventional open repair group had no complications. 4 (16%) patients in the laparoscopic duodenal perforation repair group and 2(8%) patients in conventional open repair group showed Post-operative complications as chest infection. In the conventional open repair group patients present with wound dehiscence and wound infection and Wound dehiscence and chest infection were 4(16%) and 5(20%) respectively whereas nil in Laparoscopic duodenal perforation repair group. Conclusion: Duodenal ulcer perforation is a life-threatening emergency which required urgent management for the patients. Due to the advance in duodenal ulcer perforation closure by laparoscopy it becomes popular and favorite choice. With certain criteria, laparoscopic closure of perforated duodenal ulcer is safe and effective though it was associated with longer operating time and had no impact on the outcome. Hence laparoscopic closure was better in comparison to open repair for the earlier returns to normal daily activities. Keywords: Duodenal ulcer, Laparoscopic repair, Post-operative analgesia, conventional surgery

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RESULTS OF THE SUTURE OF THE PERFORATION BY SINGLE-PORT LAPAROSCOPIC SURGERY (SPLS) FOR THE PERFORATED DUODENAL ULCER TREATEMENT

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2014.4_5.18 ◽

2014 ◽

pp. 126-132

Author(s):

Huu Tri Nguyen ◽

Van Lieu Nguyen

Keyword(s):

Duodenal Ulcer ◽

Laparoscopic Surgery ◽

Single Port ◽

Previous History ◽

University Hospital ◽

Safe Procedure ◽

Perforated Duodenal Ulcer ◽

Analgesic Requirement ◽

Duodenal Ulcers ◽

The Mean

Background Single-port laparoscopic surgery (SPLS) was increasingly used on several surgical diseases. The aim of this study is evaluation of the results of the suture of the perforation by SPLS for the perforated duodenal ulcer treatement. Methods From January 2012 to July 2014, 35 patients with perforated duodenal ulcers underwent simple suture of the perforations by SPLS at Hue University Hospital and Hue Central Hospital. Results The mean age was 45.9 ± 14.4 years. The sex ratio (male/female) was 16.5 and the mean of BMI was 19.2 ± 2.3. There was one patient (2.9%) with previous history of laparoscopic repair of perforated duodenal ulcer. The duration of the symptoms was 9.9 ± 12.3 hours. 97.1% of patients had the perforations of the anterior wall of the duodenum. The mean size of the perforation was 4.7 ± 3.4 mm (2 – 22mm). 2.9% of patients had the perforations of the posterior wall of the duodenum. The rate of the conversion to the open surgery was 2.9%. The mean operative time was 75.8 ± 33.7min, and the mean hospital stay was 5.8 ± 1.4 days. The mean of the analgesic requirement time was 2.9 ± 0.8 days. The wound length was 1.9 ± 0.1 cm. There was 5.9% of the patients had wound infection. There was no operation-related mortality. Conclusions Simple suture of the perforation by single-port laparoscopic surgery is a feasible and safe procedure, and it may be a scarless surgical technique for perforated duodenal ulcers treatement. Key words: single-port laparoscopic surgery, perforated duodenal ulcer

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RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH CHRONIC PANCREATITIS AND THE RISK OF CANCER AFTER SURGICAL TREATMENT

Problems in oncology ◽

10.37469/0507-3758-2018-64-2-228-233 ◽

2018 ◽

Vol 64 (2) ◽

pp. 228-233

Author(s):

Vladimir Lubyanskiy ◽

Vasiliy Seroshtanov ◽

Ye. Semenova

Keyword(s):

Pancreatic Cancer ◽

Chronic Pancreatitis ◽

Surgical Treatment ◽

Fibrous Tissue ◽

Pancreatic Head ◽

Head Region ◽

Intestinal Anastomoses ◽

Resection Of The Pancreas ◽

Risk Of Cancer

The aim: To analyze results of surgical treatment of patients with chronic pancreatitis (CP) and to assess the causes of pancreatic cancer after surgical treatment. Materials and methods: 137 patients had duodenum-preserving resections of the pancreas. Results: In the histological examination of the pancreas it was established that the growth of fibrous tissue was registered in patients with CP., which in 19 (13.8%) almost completely replaced the acinar tissue. In the long term after the operation from 6 months to 2 years in 8 patients (5.8%) pancreatic cancer was detected. Possible causes of tumor origin were analyzed, the value of preservation of ductal hypertension, which affects the state of the duct’s epithelium, was established. The most commonly used for treatment of chronic pancreatitis the Frey surgery removed pancreatic hypertension but in two patients during the operation an insufficient volume of the pancreatic head was reconstructed. In the case of the abandonment of a large array of fibrous tissue, local hypertension was retained in the region of the ductal structures of the head, which led to the transformation of the duct epithelium. An essential factor in the problem of the preservation of pancreatic hypertension were the stenosis of pancreatic intestinal anastomoses, they arose in the long term in 4 operated patients. With stenosis of anastomosis after duodenum-preserving resection both the hypertension factor and the regeneration factor could be realized, which under certain circumstances might be significant. Conclusion: After resection of the pancreas for CP cancer was diagnosed in 5.8% of patients. The main method of preventing the risk of cancer was performing the Frey surgery for CP eliminating pancreatic hypertension in the head region of the pancreas. Diagnosis of stenosis in the late period after resection of the pancreas was an important element in the prevention of recurrence of cancer since a timely reconstructive operation could improve the drainage of duct structures.

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