[Nutritional support in surgical treatment of patients with post-gastroresection and post-gastrectomy syndromes].

The aim of the research determine the character and peculiarities of nutritional support in surgical treatment of patients with gastroresection--and total gastrectomy syndromes. Analyzed are the results of the evaluation nourishing status of 68 patients who have had a resection intervention on the stomach. It was noted that the 26.5% of patients with clinical manifestations of diseases of operated stomach arise sub- and decompensated forms of disorders metabolism and nutrition, entailing numerous violations of homeostasis and requiring compliance with reconstructive surgical interventions. We studied the results of the implementation of the reconstructive operations with the formation of functionally active (see text for symbol) in 18 patients, suffering from the disease of stomach operated on. It is proved, that the rational nutritional support in the perioperative period allows to avoid gross violations of metabolism and provides a reasonably good compensation digestive function, significantly improving the quality of life of this category of patients.

[The regurgitation prophylaxis after the distal esophagus resection].

The clinical use of esophagogastroplasty with antireflux gastroesophageal anastomosis was analyzed basing on the data of 11 operated patients. All patients had benign strictures of the esophagus were operated on transhiatally. The long-term and early results demonstrated the efficacy of the sphincter-valve gastroesophageal anastomosis in prevention of reflux after distal esophagus resection and primary esophagogastroplasty.

[Diagnostic aspects of chronic cholangitis after cholecystectomy].

AIM: To determine the chronic cholangitis risk factors and to provide a practically significant diagnostic criteria of chronic cholangitis in patients after cholecystectomy. MATERIALS AND METHODS: Were examined the clinical, anamnestic data, clinical laboratory and instrumental studies of the condition of the hepatobiliary system in 127 patients with chronic cholangitis after cholecystectomy. The determination of microbial contamination of bile was performed during the duodenal intubation. RESULTS: In the bile microbial landscape study were noted the violation of biliary system microbiota in 92.1% of cases. Herewith identified a combination of bacterial factors with parasitic invasion (mixed infection) in 28 (22.0%) patients. Cholangitis develops in the presence of duodeno biliary reflux, duodenal motility disorders and hypotonia of Oddi's sphincter in the early postoperative period. In the late periods after cholecystectomy, cholangitis chronization defines outflow obstruction and cholestasis due to functional or organic causes in most patients. CONCLUSIONS: Risk factors for chronic cholangitis should be referred to long history of gallstone disease, performance of cholecystectomy in the emergency order against the inflammatory process of thehepatobiliary system, absence of adequate correction of postoperative hypertension of bile duct, destruction of sphincter apparatus major duodenal papilla during surgery.

[The Roux reconstruction for the correction of postresectional and postgastrectomy syndromes].

The study substantiates the efficacy of the Roux reconstruction of the upper gastrointestinal tract in the surgical treatment of postresectional and postgastrectomic syndromes. Such reconstructive operations were performed in 16 patients. There were no postoperative mortality or specific complications registered. The short and long-term follow up demonstrated good compensation of the disorders, caused by the earlier radical gastric surgery. Thus, the method of the Roux reconstruction, amplified by the creation of functionally active sphincters and valves provides the satisfactory relief of the operated stomach disease.

[Surgical treatment of hiatal hernias].

17 patients suffering from axial hiatal hernias with marked duodenogastroesophageal reflux underwent surgical treatment including selective proximal vagotomy combined with formation of closing cardia mechanism, enhancement in are flux function of pylorus, correction of duodenostasis. Specific postoperative complications and lethal outcomes were not observed. Increase of life quality was observed among patients in early and long-term postoperative periods in comparison with preoperative indices. Relapses or regurgitation disturbances were not observed either.

[Areflux choledochoduodenostomy in surgery of acute cholangitis].

The work presents an analysis of results of using an original areflux choledochoduodenoanastomosis in 32 patients with acute cholangitis developed against the background of bile hypertension. The method of correction of mechanical jaundice is supposed to be formed in the area of biliodigestive fistula of the bicuspid invagination valve from the mucosal-submucosal layers (RF Patent No 2302831 of 20.07.2007). The introduction into clinical practice of the developed method of choledochoduodenostomy allowed not only arresting cholangiogenous infection in cases of obturatuional lesions of bile ducts, avoiding lethality and severe complications in the early postoperative period, but also prevention of the development of reflux-cholangitis.

[Complex treatment of patients with pylorobulbar ulcers in combination with duodenogastric reflux]. / Kompleksnoe lechenie bol'nykh s pilorobul'barnymi iazvami, sochetaiushchimisia s duodenogastral'nym refliuksom.

The complex approach to therapy of pylorobulbar ulcers combined with duodenogastral reflux was developed and introduced into the clinical practice. The treatment stipulates the elements of functional surgery and eradicative antiinflammatory and antisecretory therapy. The use of this complex method permits to obtain the good results providing the food passage close to physiologic one, to prevent the ulcer recurrence, development of gastric mucosa pathology caused by duodenogastral reflux and persistence of Helicobacter pylori infection. As the result the patients' life quality significantly improves.

[A variant of functionally active esophagogastric anastomosis in the surgery of stenosing lesions of the esophagus]. / Variant funktsional'no aktivnogo sheinogo ézofagogastroanastomoza v khirurgii stenoziruiushchikh porazhenii pishchevoda.

A method of forming a cervical are flux esophgeal-gastric anastomosis has been developed allowing to exclude or considerably decrease the effect of esophago-gastro-pharingeal reflux on the esophageal stump mucosa after subtotal resection of the esophagus and performing one-moment esophagogastroplasty. A muscular constrictor and a circular invagination valve formed in the area of the esophagogastroanastomosis represent a single mechanism having the functional properties approximating the natural esophagocardial passage which prevents the reflux of the stomach contents into the esophagus stump and is a guarantee of prophylactics of reflux-esophagitis and stenosis of the created anastomosis.

[Choice of surgical strategy in gastroduodenal ulcer hemorrhage]. / Vybor khirurgicheskoi taktiki pri gastroduodenal'nykh iazvennykh krovotecheniiakh.

An analysis of 567 patients aged from 15 to 89 years with gastroduodenal bleedings was made. Ulcer disease of the stomach was diagnosed in 173 (30.5%) patients, ulcer disease of the duodenum--in 354 (62.4%) patients, 26 patients (4.6%) had combined gastroduodenal ulcers, 14 patients (2.5%) had ulcers of the gastroenteroanastomosis (after Billroth-II operations). Operations were fulfilled in 250 (44.1%) of all the patients. The operation of choice at the high state of bleeding is considered by the authors to be resection of 1/2 of the stomach by the method modified in the clinic. Postoperative lethality was 4%, complications were noted in 12% of the patients. All the complications were nonspecific, i.e. characteristic of any operations on organs of the abdominal cavity. Incompetence of the anastomosis sutures was not noted which in our opinion can be accounted for by a specific method of forming the anastomosis. The average amount of bed-days after the operations was 19.5 +/- 3.3.

[Diagnosis and surgical treatment of postbulbar ulcers of the duodenum]. / Diagnostika i khirurgicheskoe lechenie pri postbul'barnykh iazvakh dvenadtsatiperstnoi kishki.

The method of surgical treatment of postbulbar ulcers of the duodenum based on the data of their localization, complications, functional state of the stomach and duodenum, technical skills of the surgeon includes radical ablation of the ulcer, reestablishment of the gastroduodenal continuity with the formation of the functionally active anastomosis or selective proximal vagotomy. The method allows to considerably lessen the amount of complications at the early postoperative period and to obtain good functional results at late terms of observations.

[Therapeutic complex in therapy of patients with complicated course of pylorobulbar ulcers]. / Kompleks lechebnykh meropriiatii v terapii bol'nykh s oslozhnennym techeniem pilorobul'barnykh iazv.

Combined treatment of pylorobulbar ulcers associated with duodenogastric reflux incorporated surgery, antiinflammatory and antisecretory therapy. The treatment provides preventing ulcer recurrence, gastric mucosa affection caused by duodenogastric reflux and infection Helicobacter pylori. Finally, this led to improved quality of life.

[Sphincter-valve gastroduodenal anastomosis in surgery of stomach ulcer]. / Zhomno-klapannyi gastroduodenoanastomoz v khirurgii iazv zheludka.

A method of gastroduodenoanastomosis has been developed which allows exclusion or considerable reduction of the pathological effect of the duodenogastric reflux upon the gastric stump mucosa after distal resection of the stomach in patients with gastric ulcer. Complex examinations of the patients after operations have shown that the developed by the authors sphincter-valvular gastroduodenoanastomosis facilitates the rhythmic-portion evacuation of the gastric contents and prevents the reflux of the duodenal contents into the gastric stump.