SURGICAL TREATMENT OF BENING ESOPHAGEAL STRICTURES AFTER CORROSIVE INJURIES.

The research is based on the results of the examination and treatment of 156 patients who received treatment for extended benign esophageal strictures after corrosive injuries in the department of diseases of the esophagus and the gastrointestinal tract of the State Institution "V. T. Zaitsev Institute of General and Urgent Surgery of NAMS of Ukraine" for the period from 2000 to 2016. Surgical treatment by the developed in our hospital technique performed in the patients of the main group and the classical methods of surgery were used in the patients of comparison group. The developed in our clinic method of one-step transhital esophagogastroplasty with formation of a single anastomosis on the neck in patients with extended benign esophageal strictures after corrosive injuries in the state of compensation and subcompensation can be considered as a method of choice. Adequate preoperative verification of the type of extended damage by the cicatricial process of the upper part of digestive tract and the impossibility of eating in a natural way in the acute postburn period, as well as significant nutritive disorders in patients, provide the basis for two-step surgical treatment. This approach involves formation of gastrostomy at the first step for the restoration of trophological status of the patient and esophagoplasty at the second step. The two-step surgical treatment of patients with extended benign esophageal strictures after corrosive injuries with the formation of contact gastrostomy at first step and the implementation of esophagogastroplasty on the second step promotes improvement of treatment outcomes and life quality of the operated patients.

[Surgical tactic in patients with high risk of occurrence of the intestinal anastomoses sutures insufficiency].

The prognosis criteria for development of the intestinal anastomoses sutures insufficiency were elaborated, basing on analysis of the risk factors occurrence. Surgical tactic of treatment of the patients was substantiated, depending on the risk grade presence. In presence of high or moderate risk of the sutures insufficiency occurrence the methods of the deferred intestinal anastomoses formation were elaborated, excluding necessity of multistage intraabdominal operative interventions performance. Introduction of curative-diagnostic approach proposed promotes lowering of postoperative complications rate and lethality.

[A modified classification of chemical esophageal burn and its consequences].

A modified classification of esophageal chemical burn and its consequences, based on the now existing classifications summary and the clinic experience analysis is presented.

[Surgical correction of disorders of intestinal phases of gastric secretion in the treatment of peptic ulcer and its complications]. / Khirurgicheskaia korrektsiia narushenii kishechnoi fazy zheludochnoi sekretsii v lechenii iazvennoi bolezni i ee oslozhnenii.

Shown in the paper is a possibility of surgical correction of disturbances in the intestinal phase of gastric secretion in treating peptic ulcer and its complications which are encountered in an overwhelming majority of patients. Sympathectomy of relevant vascular trees is regarded as a pathogenetically validated procedure as is correction of duodenal motility combined with selective proximal vagotomy and excision of the ulcer. It is shown that truncal and selective vagotomy can aggravate the existing disorders of the intestinal phase of gastric secretion.

[Methodology of investigations on the intestinal phase of gastric secretion depending on the methods for surgical treatment]. / Metodika issledovaniia kishechnoi fazy zheludochnoi sekretsii v zavisimosti ot metodov operativnogo lecheniia.

The paper presents the methodology of conducting those investigations designed to study the intestinal phase of gastric secretion, with the duodenal pH having been taken as the integral index. An acetylcholine test has been developed suggesting to us a preservation of the inhibitory duodenogastral reflex. The study into the gastric secretion in 69 patients with complications of peptic ulcer showed that the intraduodenal pH was disturbed in 39.1 percent of the patients, which fact warrants medicamentous and surgical correction to be instituted in them.

[The meaning of gastric secretion intestinal phase disorders in the pathogenesis of ulcers and their surgical correction]. / Znachenie narushenii kishechnoi fazy zheludochnoi sekretsii v patologeneze iazvennoi bolezni i ikh khirirgicheskaia korrektsiia.

The data concerning the disorder of the gastric secretion intestinal phase in patients with complicated forms of ulcer disease and with recurrent ulcer as well are presented. The mechanism was shown, which if noneliminated can cause nonfavourable result of the operation performed for the ulcer disease complications. The data presented trust the necessity of more meticulous studying of disorders of the gastric acidproducing intestinal phase in surgical gastroenterology.

[The meaning of duodenostasis in the intestinal phase gastric secretion disorders in bleeding duodenal ulcer]. / Znachenie duodenostaza v geneze narushenii kishechnoi fazy zheludochnoi sekretsii pri krovotochashchei iazve dvenadtsatiperstnoi kishki.

The data on the duodenal motor-evacuational function investigation in 62 patients with an ulcer bleeding are presented. It was established that the degree of duodenal chronic impassability is correlating with the degree of disorders of the gastric secretion intestinal phase. That's why it is necessary to stipulate the elimination of hyperchlorhydria in all phases of gastric secretion while such complication correction.

[Significance of duodenal stasis in the etiology of recurrent hemorrhage in duodenal ulcer]. / Znachenie duodenostaza v vozniknovenii retsidiva krovotecheniia iz iazvy dvenadtsatiperstnoi kishki.

In 92 patients the influence of duodenostasis on possibility of occurrence of rehemorrhage from duodenal ulcer was studied. It was established that the heightened risk of rehemorrhage is promoted by disorders of motility, blood flow and acid production.