Nikolay N. Krylov, Elena A.Pyatenko
Sechenov First Moscow State Medical University
The formation and development of organ-preserving operations with vagotomy in the second half of the 20th century in the faculty surgery clinic at the 1st Moscow Medical Institute is analyzed. The authors study the clinic when it was under the direction of academic M.I. Kuzin, during which the idea arose to reduce the negative effects of extensive resection of the stomach in patients with peptic ulcer. At first, in cases of peptic ulcer of the duodenum and later in cases of gastric ulcer, the clinic’s staff consistently solved difficult issues associated with pathogenetic treatment. From organ-preserving gastrectomy combined with stem vagotomy, the clinic moved on to organ-preserving and pylorus-preserving operations: a selective proximal vagotomy – isolated and combined with duodenoplasty in cases of duodenal ulcer. From large-scale gastrectomy to stem vagotomy with drainage of gastric ulcer. Surgeons developed a new operation of “expanded proximal selective vagotomy”, which allowed for adequate denervation of all parts of the acidogenic area of the stomach, and justified its use in cases of duodenal ulcer and the rejection of it in cases of stomach ulcer. The 30-year history of using different vagotomy variants led to a 10-fold reduction in mortality rates and eightfold reduction in patients becoming disabled. The staff of the P.M. Postolov Department of Surgery and Kuzin became laureates of the USSR State Prize in 1987. In order to prevent the development of reflux gastritis after stomach draining operations, the need to use the organ-sparing Roux method of stomach resection with anastomosis was substantiated. Retrospective analysis of treatment results, including the study of quality of life before and during a period from five to 25 years after surgery, provided for the formulation of an algorithm for individualized care to patients with peptic ulcer disease.
Keywords: peptic ulcer disease, surgical treatment, organ-preserving gastrectomy, vagotomy, history of medicine