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A new method of duodenal closure in stomach reconstructive resection in patients with pathologic disturbances after vagotomy with drainage operation is worked up. 6 patients have been operated. No postoperative complications were observed. All the method advantages are evident.

Under analysis are results of transgastric vagotomy in 211 patients with ulcer disease of the duodenum operated upon at the period from 1979 to 1989. The transgastric selective proximal vagotomy (TSPV) was used in 150 patients, an original authors' extensive TSPV--in 33 patients, combined transgastric vagotomy (CTV)--in 28 patients. Long-term results of TSPV are recognized to be excellent and good in 79.1% of the patients, satisfactory--in 9.8%, unsatisfactory--in 11.1%. An analysis of causes of unsatisfactory results of TSPV is made. Advantages of the method of extensive TSPV were shown. The CTV is thought to be expedient in patients in urgent surgery and in patients with severe coexistent diseases.

The influence of transgastric selective proximal vagotomy (TSPV) on the cardia functional state was studied in 120 patients with ulcer disease of the duodenum. It was established that seromyotomy in the zone of cardia and lesser curvature of the stomach when performing TSPV resulted in disturbance of the constrictor-valvar mechanism of the esophago-gastric passage. Fundoesophagography does not allow the insufficient closure of the cardia to be adequately corrected. The significance of fundoplication is stressed in order to restore the mechanism of cardia closure after TSPV.

An analysis of results of transgastric selective proximal vagotomy in 90 patients with ulcer disease of the duodenum enabled the authors to conclude that seromyotomy of the lesser curvature of the stomach when performing transgastric selective proximal vagotomy fails to ensure valuable parasympathetic denervation of the zone in question which results in a number of cases in preservation of uninterrupted gastric acid formation of high intensity and in the development of recurrent ulcer.

The surgical anatomy of vagus nerves was studied in 25 corpses and in protocols of operations-vagotomies in patients with ulcer disease of the duodenum. The authors consider incomplete vagotomy to be responsible for insufficiently decreased secretion of hydrochloric acid after operation in 24 (23.1%) of 104 patients examined. It was found that both the right and the left vagus nerves had different numbers of trunks and branches. The knowledge of variants of branching and disposition of the vagus nerve branches decreases the risk of incomplete and inadequate vagotomy.

Remote results within the terms of from 1 to 3 years in 60 patients and the working ability in 73 patients subjected to selective proximal vagotomy (SPV) or SPV with drainage of the stomach were studied. Functional disorders were observed much more rarely after the isolated SPV. The use of benzohexasonium and electrostitmulation of the stomach in the early postoperative period allows preventing the development of functional disorders. The SPV ensures an early recovery of the working ability.

An analysis of results of the endoscopic examination of 320 patients who had been subjected to various operations for ulcer disease of the stomach and duodenum has shown that sphincter-preserving operations (selective proximal vagotomy without drainage of the stomach and pylorus-preserving resection of the stomach) in treatment of ulcer disease of the stomach and duodenum with correction of disturbances of duodenal passability is the most reliable method for prevention of duodeno-gastric reflux and reflux-gastritis.

The intramural selective proximal vagotomy in its extended form was performed in 110 patients with polyroduodenal ulcer. The technique is described. Good functional results were obtained. A conclusion is made that when performing the selective proximal vagotomy a wide mobilization of the terminal portion of the esophagus can be substituted by the circular extramucosal cardiotomy.

The method of roentgen planimetry was used in 79 patients with pyloroduodenal ulcer at different terms after selective proximal vagotomy (SPV) with/without draining operations in order to study the rate of emptying the stomach. It was shown that the evacuatory function of the stomach in remote periods after isolated SPV was determined by the state of the closing function of the pylorus, after SPV with drainage of the stomach--by a draining operation. Alterations of the duodenal passage not corrected during operation manifested themselves in remote periods after SPV as slower emptying of the stomach.