[Late reinterventions after the surgical treatment of gastric and duodenal ulcer]. / Reinterventii tardive dupa tratamentul chirurgical al ulcerului gastric si duodenal.

A number of 87 reinterventions performed during a 5-year-period for late complications of the gastric and duodenal ulcer surgery are analysed. In most of them (64 cases), the cause of the reintervention was a postoperative ulcer. A long afferent loop (6 cases), the dumping syndrome (4 cases), the stenosis of the anastomosis opening (6 cases) and the primitive neoplasm of the gastric stump (7 cases) represented other causes of reintervention. The immediate postoperative results were very good and good in 69 cases. The risks related to the specific character of this surgery materialized themselves in 14 postoperative complications (anastomotic fistulas, haemorrhages from the anastomosis, stress ulcers etc.), which required iterative operations; the postoperative death rate attained 3.4%. The analysis of these postgastrectomy syndromes is an opportunity to discuss about the failure factors in the surgery of the gastric and duodenal ulcer, the possibilities of exploration and the principles which should guide the reparative therapy.

[Cephalic duodenopancreatectomy with preservation of the pylorus in treating a malignant tumor of Vater's ampulla]. / Duodenopancreatectomia cefalica cu conservarea pilorului în tratamentul ampulomului vaterian malign.

The paper reports on the clinical observation of a patient with mechanical jaundice in which the biliary obstruction was caused by an ampulla of Vater. Cephalic duodenopancreatectomy with preservation of the pylorus was used. Distally the duodenum was excised to its intersection with the mesenteric vessels. For recovery of the digestive circuits, a loop excluded "en Y" à la Roux ascending transmesocolically was used. The anastomoses had the following stages: choledochojejunostomy (T-T) the most proximal; pancreatic-jejunal anastomosis (T-L); and the most distal, the duodeno-jejunal one (T-L). After surgery, the evolution was good, and the patient left the hospital with the wound cured. Starting from this observation, the authors discuss aspects connected with the technique of cephalic duodenopancreatectomy with or without preservation of the pylorus.

Roux-en-Y gastrectomy: early and late results.

Results obtained in 16 patients by Roux-en-Y gastrectomy (Moskowicz procedure) are presented. According to Langhans a high gastrectomy ascending on the lesser curvature to 2 to 3 cm below the cardia and unaccompanied by a sectioning of the vagal branches was performed. The Roux-en-Y resection was used only in exceptional situations, being preferred to the standard Billroth II operation in order to avoid the biliopancreatic reflux into the gastric remnant. It was performed as a primary intervention in 13 cases (penetrating gastric or duodenal ulcers, gastritis due to biliar reflux) and as a revisional surgery in three patients with disturbances of the operated stomach. The best results were obtained in gastritis due to biliar reflux, in gastric ulcers Johnson I type, and when the method was used as a revisional surgery. When it was used as a primary operation in duodenal ulcers, the main risks depend of two things: the duodenal fistula and the ulcerous recurrence. Duodenal stump disruption has not specific causes and as well as in all the Billroth II resections may results from less than satisfactory duodenal closure. This complication was noted in one patient. Concerning the risk of the anastomotic ulcer, it is particularly increased in the Billroth II-Roux gastrectomy compared with the other types of gastric resections. When the operation is unaccompanied by vagotomy, the risk has maximum values. In this clinical material the ulcerous recurrence was noted in four patients.