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Year 2010 Vol. 18 No 3

GENERAL AND SPECIAL SURGERY

SACHEK M.G., ERMASHKEVICH S.N.

ERADICATION THERAPY IN PREVENTION AND TREATMENT OF ANASTOMOSITIS IN THE PEPTIC ULCER SURGERY

Objective. To study the connection of H. pylori with the development of the postgastroresectional anastomositis and efficiency of the eradication therapy in its prevention and treatment.
Methods. 63 patients were inspected in the nearest period after gastrectomy because of peptic ulcer disease. The patients were divided into two groups. Revealing H. pylori in both groups was carried out by the histological method; in the first group the determination of H. pylori was done by PCR-method. 46 patients were included in the first group. Eradication of H. pylori wasn’t carried out in them. 17 patients were included in the second group. The preoperative eradication therapy was performed in 16 H. pylori-positive patients. The upper gastrointestinal endoscopy with the biopsy of the anastomosis zone was carried out in all the patients 10–12 days after the operation.
Results. In the first group anastomositis was diagnosed in 15 (32,6%) patients. Highly pathogenic types of H. pylori (сagA vacAs1a/m1a) contributed to the development of anastomositis which severity correlated (rs=0,85; р=0,000028) with the degree of their dissemination of the gastric mucosa. The number of neutrophils in the gastric mucosa in the anastomosis zone was more in H. pylori-positive patients and it also increased with the growth of pathogenic characteristics of H. рylori (presence of genes сagA and vacA, type vacA, the degree of dissemination of the mucosa with H. рylori). In the second group anastomositis was diagnosed in 3 (17,6%) cases. The number of neutrophils in the gastric mucosa in the anastomosis zone in case of H. pylori elimination in the patients without anastomositis approximated their number in H. pylori-negative patients.
Conclusions. Preoperative eradication therapy is an effective method of preventive maintenance of anastomositis in the peptic ulcer surgery.

Keywords: peptic ulcer, partial gastrectomy, anastomositis, Helicobacter pylori, eradication therapy
p. 32 - 46 of the original issue
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