[Surgical strategy for juxtapapillary ulcers of the duodenum]

Results of surgical treatment of 89 patients with ulcer of the duodenum with postbulbar localization were studied. A classification of postbulbar ulcers was proposed taking into consideration the degree of involvement of bile-excreting pathways and major duodenal papilla into the periulcerous process. In extrapapillary ulcers without involvement of bile-excreting pathways in the cicatricial-ulcerous process resection of the stomach after Bilroth I is recommended with performing gastroduodenal anastomosis with a single layer suture. Resection of the stomach supplemented with biliodigestive anastomosis is recommended in cases with suprapapillary ulcers with the involvement of choledochus. Mechanical jaundice complicated by juxtapapillary ulcer can be cut off by endoscopic papillosphincterotomy. Fulfillment of pancreatoduodenal resection is possible in cases of deep injury of the pancreatic head.