Prevention and treatment of motor-evacuator disorders after pylorus-mimicking gastrectomies

The research is dedicated to the problem of motor-evacuator disorders in patients with peptic ulcer of the duodenum who have undergone pylorus-mimicking gastrectomies. The work analyzes the influence of various methods of forming a gastroduodenostomy on the restoration of motor function of the operated stomach in the early postoperative period. The relevance of the topic is due to the high frequency of postgastrectomy motor-evacuator disorders and the need to develop effective strategies for their prevention and treatment.

The dissertation contains a comprehensive study of the motor-evacuator function of the gastrointestinal tract before and after surgical treatment, as well as the substantiation of the use of an autonomous electrostimulator of the gastrointestinal tract to correct motor disorders of the stomach stump.

In recent times, thanks to the widespread introduction of new generations of intestinal-selective acid-reducing drugs, the conduct of Helicobacter pylori eradication therapy, a significant decrease in operative activity in uncomplicated peptic ulcer has been observed [Pancyrev Yu.M., 2003; Arsene D., 1989; Donahue Ph.E., 2000; Khoshbaten M., 2006]. At the same time, the number of operations performed on urgent indications and against the background of complications (hemorrhage, penetration, stenosis, perforation) has no tendency to decrease, but rather, is increasing [Afendulov et al., 2005; Gostishchev V.K., Evseev M.A., 2007; Zhuravlev G.Yu., 2006; Lebedev N.V. et al., 2007; Chernookov A.I. et al., 2007; Madrona A., 2001].

Over the past century, the improvement of methods for the surgical treatment of gastroduodenal ulcers has been carried out, from the method of gastrotomy to the creation of "artificial" valves and sphincters [Babalich A.K., 1999; Vitebsky Ya.D., 1988; Voznesenskiy V.A., 1930; Ganichkin A.M., Reznik S.D., 1973; Zherlov G.K., 2000; Yudin S.S., 1965; Berber E., 2002; Donahue Ph.E., 2000; Kieninger G., 1979; Lu Y.-F., 1999; Tomita R., 2005; Weil P.H., 1999]. All this testifies to the dissatisfaction of surgeons with the immediate and, what is very important, the remote results of the operations. At the same time, one of the most frequent complications of the early postoperative period is motor-evacuator disorders of the stomach stump and anastomoses, which occur, on average, in 25-30% and more operated patients [Davydkin V.I., 1994; Michiura T., 2006; Nakabayashi T., 2002].

All this requires the search for, on the one hand, an optimal method of surgical treatment, and on the other, the development of a strategy for managing the early postoperative period aimed at timely restoration of the motor-evacuator function of the operated stomach.

The aim of the work: substantiation of the use of an autonomous electrostimulator of the gastrointestinal tract in the prevention and treatment of motor-evacuator disorders in patients before and after surgical treatment for peptic ulcer of the duodenum.

To achieve the stated goal, the following tasks were set:

1. To study the frequency and character of motor-evacuator function in patients with gastroduodenal ulcers before surgery.

2. To study the influence of the method of forming a gastroduodenostomy on the frequency and character of motor-evacuator disorders in the early postoperative period.

3. To study the influence of various modifications of an autonomous electrostimulator of the gastrointestinal tract on the restoration of motor function of the operated stomach.

4. To develop an algorithm for managing the early postoperative period after surgical treatment of gastroduodenal ulcers, aimed at correcting motor-evacuator function.

Scientific novelty

For the first time, a comprehensive study of the motor-evacuator function of the stomach in patients operated for peptic ulcer of the stomach and duodenum using pylorus-mimicking technologies, depending on the method of forming a gastroduodenostomy, preoperative motor function of the gastrointestinal tract, and the level of acid production has been conducted.

Indications for the use of various modifications of an autonomous stimulator of the gastrointestinal tract in patients in the early postoperative period after stomach surgery have been determined, and an algorithm for restoring the motor-evacuator function of the operated stomach in the early and near postoperative periods has been developed.

Practical value of the obtained results

The work has a direct practical orientation, as during the research an acceptable method for restoring the motor-evacuator function of the operated stomach in the early and near postoperative periods has been created and tested by surgeons-gastroenterologists. The conducted generalization and assessment of a large clinical material have made it possible to formulate indications for the use of various modifications of an autonomous electrostimulator of the gastrointestinal tract, and the role of medication and physiotherapy treatment of motor disorders of the stomach stump in the early postoperative period has been determined.

Among the obtained results, an important practical value have the recommendations for preoperative and postoperative prevention of motor-evacuator disorders. The timing of medical rehabilitation in the early and near postoperative periods has been substantiated and recommended, which can be recommended for all medical institutions engaged in issues of medical rehabilitation after surgical treatment of gastroduodenal ulcers.

Presentation of the work

The main provisions of the dissertation were reported and discussed at the 2nd Scientific and Practical Conference "Rodinskie Chteniya" (city of Seversk, 2006) and the Tomsk Regional Society of Surgeons (2007).

As a result of the research, 12 scientific papers have been published in journals and collections, including 2 in the central journal recommended by the VAK RF.

Implementation of the work

The provisions of the dissertation are used in the educational process and in the treatment of patients with peptic ulcer in the clinic of the Research Institute of Gastroenterology of SibGMU, the Department of Surgery of FGZh i PPS GOU VPO SibGMU Roszdrava, and the surgical departments of TSMCH-81 (city of Seversk).

Propositions to be defended:

1. The use of complex methods of research in peptic ulcer allows identifying the cause of motor-evacuator disorders caused by the violation of the function of the pyloric section.

2. The formation of a pylorus-like gastroduodenostomy ensures a more timely and adequate restoration of the motor-evacuator function of the stump of the operated stomach.

3. The use of an AES GI-catheter for stimulation contributes to a reliably earlier normalization of the motor-evacuator function of the stump of the operated stomach compared to medication stimulation.

4. The use of AES GI in the early postoperative period favorably affects the course of the postoperative period.

Volume and structure of the dissertation

The dissertation is presented on 137 pages of typed text. The work consists of an introduction, five chapters, conclusion, conclusions, and a bibliography, illustrated by 27 tables and 41 figures. The bibliography contains 159 works, of which 93 are domestic and 66 are foreign authors.