[Tactics of surgical treatment of patients with complicated peptic ulcer disease].

Article presents the results of medical treatment after peptic ulcer surgery. I group--59 patients with late complications after peptic ulcer surgery and II group--16 patients with complications of peptic ulcer disease, operated in presence of absolute indications. 13C-UBT and RUT of biopsy material were used to diagnose Hp infection. Hp positive patients received antibacterial treatment. After 1 month from the end of therapy and 1 year after Hp eradication control investigations by 13C-UBT and endoscopy were performed. 77.3% of all and 84.4% of early non treated patients were Hp positive. All patients (of I and II gr.), who followed control testing after antibacterial treatment were finally detected as Hp negative. In I group, control endoscopy revealed epitelization or scarring of ulcer and reduction of inflammatory changes in gastric and duodenal mucosa in all 44 cases of eradication of Hp infection (in 2 patients with peptic ulcer of GEA ulcer relapsed in later). In II group, in 8 patients, who received antibacterial treatment additionally to surgical method, any late complications after surgery were not revealed. In other 6 Hp positive patients: 2--ulcer recurrence and 2--development of chronic gastritis of operated stomach were noted, which required the treatment of Hp infection in future. It is concluded that 1)surgery does not change Hp-status of patients and Hp infection retains in more than 80% of cases; 2) ulcer recurrence, chronic gastritis of operated stomach or its stump are associated with Hp and regress after Hp eradication; 3) progression of gastritis into atrophic remain after surgery, which increases risk of cancer development and there is possibility of its regression after antibacterial treatment of Hp infection. The recommendations were worked out: 1) perforated, bleeding or stenosing ulcer must be treated only by ulceroraphy, suturing or pyloroplasty respectively, added with subsequent Hp eradication therapy for the prevention of late complications after peptic ulcer surgery; 2) vagotomy or partial gastrectomy must be a forced intervention in cases of decompensate pylorostenosis, resistant to treatment ulcers, as ulcers non-healing or recurring after adequate conservative treatment. Subsequent verification and eradication of Hp infection are necessary.