Bashkiria Medical University, City Clinical Hospital N 18, Republic Clinical Hospital named after G.G. Kuvatova, Ufa, RUSSIA
The problem of treatment of ulcerative gastroduodenal bleedings (UGDB) continues to remain urgent. The prevalence of ulcer disease in the RF and majority of CIS countries, has no tendency to decrease and constitutes 1,7-5% and the incidence rate - 1,6-6,5 ‰, due to persistent high social tension in society (Maistrenko N.A. 2003).
The aim of the study. Improvement if the results of diagnostic and treatment of patients with ulcerative gastro-intestinal bleedings.
Materials and methods: The work included to the results of examination and treatment of 353 patients with bleeding from chronic gastric ulcers and duodenal ulcers, treated in the period from 2004 to 2009 in the MI SCH No 18 and RCH named after G.G. Kuvatova of Ufa city. There were 261 (73.9%) men, and 92 (26.1%) – women among the examined. The average age of male patients was 48.0+0.67 (18 - 85 years), women patients - 58.3+1.0 (17 - 93 years). There were 108 (30.8%) patients older than 60 years. 18.2% were admitted in the first 6 hours of hemorrhage, 17.8% in 12 hours, and 29.1% within 24-hours, and 34.9% - after 24 hours, that is most of patients are delivered within 24 hours against developed hemodynamic disorders. Chronic gastric ulcer was the source of bleeding in 36.9% of cases, duodenal ulcer - in 59.4%. Bleeding from the combined chronic gastric and duodenal ulcers was observed in 3.7%. Division of patients according to J.A.Forrest classification: Type I (FI) 51 patients (14.4%), Type II (FII) 190 patients (53.8%), type III (FIII) 112 patients (31.8%). 160 (45.3%) patients were admitted with mild bleeding, 108 (30.6%) with moderate, 85 (24.1%) patients with severe bleeding.
Results of the study: As a criterion for the identification of surgical tactics in ulcerative gastroduodenal bleedings, the suggested forms of bleeding are: arterial and venous. 58 (16.4%) patients had arterial bleeding, 295 (83.6%) venous. Differential diagnosis of the type of bleeding is carried out by clinical, endoscopic and laboratory data. Based on data obtained by us on the differential diagnosis of bleeding, the patent for the invention No 2407445 dated December 27, 2010 of the Russian Federation was acquired.
Conclusions: The use of the set of differential-diagnostic signs of bleeding and forms of adequate surgical approach offered by us helped to reduce overall mortality to 3.5% and postoperative to 2.1%
LAPAROSCOPIC NISSEN FUNDOPLIATION AND HELLER’S CARDIOMYOTOMY IN GEORGIA
M. KILADZE, D. ELGANDASHVILI, D. GORDELADZE, T. KANDASHVILI, M. DVALI
Tbilisi City Clinical Hospital ¹ 1; Thoracoabdominal Clinic; Internal Medicine Clinic;
Background and aims: Thoracoabdominal Clinic is the only clinic in Georgia performing laparoscopic treatment of Gastroesophageal (GE) junction benign pathologes in Georgia. Internal Medicine Clinic is actively involved in post surgery treatment of patients with this pathology. Result analysis and proposals to improve current situation are given.
Materials and methods: 97 laparoscopic procedures have been performed since year 2005 in Thoracoabdominal clinic. With 81 for Gastroesophageal Reflux Disease (GERD) and 16 for esophageal achalasia. In every case of GERD floppy Nissen fundoplication was performed with cruroraphy in 61 cases and Heller’s myotomy has been done in all 16 cases with achalasia. We have been performed acording to standardized technique and preop examinations include endoscopic, radiologic and manometric data.
Results: Male/female ratio was 2/1 for GERD and 5/1 for achalasia. Main operative time 50 min for fundoplications and 45 min for myotomy. Main hospital stay was 3 days for both pathologies. No early health threatening complications observed. Severe dysphagia well treated by balloon dilation was observed in 1 case after fundoplication. All cases with Heller’s myotomy had perfect results.
Conclusion: According to world approved and our results laparoscopic approach is method of choice for GE junction benign pathologies surgical treatment. As main problem against larger application for above mentioned approach in Georgia we consider subjective factor-an old stereotypes-those result in lack of institutional communications between gastroenterologists and deficiency of trust of local surgical community in this method.