[Surgical treatment of patients with ulcerative pyloroduodenal stenosis]

The article discusses the results of surgical treatment of 342 patients with ulcerative pyloroduodenal stenosis. Selective proximal vagotomy (SPV) and truncal vagotomy (TV) with various operations were conducted in 202 patients, resection of the stomach--in 149 patients. To preserve the pylorus in the presence of anatomical conditions the authors combined SPV with duodenoplasty or pyloroduodenolysis (25 patients). The immediate results were best after vagotomy (0.4% fatal outcomes). Among 140 patients who underwent resection 5 (3.6%) died. Postoperative gastrostasis was encountered most frequently after vagotomy in patients with decompensated stenosis (17%). Bearing in mind marked and stable (up to 3 years) inhibition of gastric bioelectric activity occurring, according to the results of electrogastrography, after SPV, the authors consider decompensated stenosis too be a contraindication for any type of vagotomy. In the late-term period current peptic ulcers were revealed after SPV in 6.2%, after TV in 6.1%, and after resection in 2% of cases. Intraoperative pH measurement is recommended to improve the late-term results after vagotomy; it reduced the incidence of recurrences to 1.6%.