Minimally invasive technologies in the treatment of ulcerative pylorobulbar stenosis
Background. The purpose was to develop approaches to minimally invasive treatment of patients with ulcerative pyloroduodenal stenosis. Materials and methods. In 2015–2018, at the department of surgery of the digestive organs of the State Institution “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine”, 36 patients with ulcerative pyloroduodenal stenosis were treated using endoscopic, combined laparoendoscopic and laparoscopic operative techniques, of them isolated endoscopic balloon dilation of the pylorus was performed in 27 patients, combined laparoendoscopic intervention — in 9 persons. There were 24 men and 12 women, with the mean age of (45.3 ± 5.2) years. Results. Compensated stenosis was diagnosed in 7 patients (19.5 %), subcompensated — in 21 (58.3 %), decompensated — in 8 (22.2 %). During the study, we specified and developed the well-known and new indications for endoscopic balloon dilation of the pylorus and duodenum and combined laparoendoscopic intervention performed in all patients, depending on the degree of pyloric stenosis. Complications in the immediate postoperative period occurred in 1 patient (2.7 %) in the form of perforation of the dilation zone. There were no lethal outcomes. The remote observation period was 7–12 months. Endoscopic, radiological and clinical signs of recurrence of peptic ulcer and stenosis were not detected. Conclusions. The method of minimally invasive endoscopic and combined laparoendoscopic interventions in the treatment of ulcerative pyloroduodenal stenosis is characterized by minimal complications, good efficacy and the absence of disease recurrences in the long-term period.
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