Surgical methods for correcting chronic duodenal obstruction in combined complications of duodenal ulcer

Objective: Optimization of diagnostic methods and adequate selection of corrective surgical interventions for disorders of duodenal patency of the duodenum with combined complications of peptic ulcer disease. Materials and Methods: The examination and treatment results of 132 patients with ulcerative colitis and chronic duodenal ulcers (CDPU) were analyzed. A direct correlation was established between the duration of the ulcer history and the incidence of CDPU manifestations: the largest group of patients (46.9%) had a disease history of over 15 years. The diagnostic search was based on a comprehensive approach, including the assessment of clinical markers (the presence of bile in the stomach during FGDS - 94.8% of cases) and a step-by-step radiographic diagnostics: routine fluoroscopy of the stomach and duodenum; probe duodenography (under hypotension and without relaxation). Results: Surgical tactics were determined based on a comprehensive intraoperative signs and a scoring assessment of the morphofunctional state of the gastroduodenal complex (according to N.A. Nikitin). In 20.5% of patients with compensated functional chronic duodenal ulcer disease, standard interventions (SPV, duodenolysis, Hofmeister-Finsterer resection) were deemed sufficient. In the remaining 79.5% of cases, the severity of duodenostasis required specialized corrective techniques: Strong's procedure, duodenojejunostomy (DJ), or duodenal exclusion by Roux-en-Y gastrectomy. The overall postoperative complication rate was 15.2%. The complication rate depended on the type of primary intervention: With maintained duodenal passage (n=59), postvagotomy gastrostasis (5.1%) and early afferent loop syndrome (3.4%) were the most common complications. With duodenal exclusion (n=73), specific complications included Roux-en-Y stasis syndrome (4.1%) and anastomositis (4.1%). Conclusion: Optimization of surgical tactics for comorbid duodenal ulcers and chronic duodenal ulcers is based on a multifactorial analysis of the pathogenesis of both diseases, their stages, and the severity of functional disorders. A comprehensive analysis of our clinical data indicates a shift toward individualized interventions with a focus on organ-preserving technologies, which significantly reduces the incidence of postoperative complications.