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Results of surgical treatment of 271 patients with malady recurrence after perforative gastroduodenal ulcer closure were adduced. Resectional methods of treatment were conducted in 118 patients, vagotomy combined with the stomach draining procedure--in 106, in combination with ulcer extraduodenization and duodenoplasty--in 47. Conduction of organpreserving operation with ulcer extraduodenization and duodenoplasty must be supposed mostly rational.

The treatment effectiveness of 913 patients with postoperative recurrence of gastric and duodenal ulcer was studied. The peculiarities of reoperation conduction, application of prognostic criteria permitted to improve significantly the results of social rehabilitation of patients, and also prophylactic measures directed to avert the disease recurrence were elucidated.

In connection with the development of intraabdominal complications, 71 (4.3%) patients underwent relaparotomy. Peritonitis and intraabdominal abscess were the most frequent causes (61.9% of cases) of the repeated intervention. Lethality was 29.5%.

In treatment of recurrent and peptic postvagotomy ulcer, the performance of gastric resection is indicated. Of 53 patients with a recurrent ulcer, 20 had a "difficult" low penetrating ulcer. With the aim ot prevent duodenal suture failure, gastric resection in these patients was performed using the developed by the authors method which permitted to ensure safety of the single-layer suture of a duodenal stump with preservation of food passage through the duodenum. After truncal vagotomy with Jaboulay drainage operation, a defect in the duodenal wall was eliminated by means of creation of anastomosis with a gastric stump.

The results of operative treatment of 20 patients with a perforated giant duodenal ulcer have been analysed. The difficulties associated with closure of a perforated hole and duodenal stump management in performance of gastric resection were noted. It was established that closure of a giant perforated duodenal ulcer was a palliative measure, which saved the patients from death but entailed the disease recurrence requiring reoperation.

The case records of 419 patients with complicated gastric and duodenal ulcer disease were analysed. Frequent asymptomatic course of the ulcer disease was noted in workers of the metallurgical and engineering industry. Different modifications of Billroth resection of the 2/3 of the stomach were used in 240 patients, selective proximal vagotomy (SPV) with ulcer excision--in 87, transverse gastric resection with preservation of the pyloric sphincter--in 30, closure of a perforative hole--in 60, closure of a perforative hole with excision of the ulcer margins and bilateral truncal vagotomy--in 2. The most favourable long-term result was noted in patients after SPV with ulcer excision and transverse gastric resection with preservation of the pyloric sphincter.

Examined were 164 patients at the long-term period after closure of a perforative ulcer of the stomach and duodenum. The negative effect of smoking on acid production and protective barrier of gastroduodenal mucosa leading to worsened healing of an ulcer closed and its recurrence in 50% of the patients operated on has been established. It was noted that in smokers, irrespective of a number of the cigarettes being smoked, an excellent and good long-term result was observed 2.5 times less often, and a poor one--3 times more often than in non-smokers.

In a work, the information about the patients who had their duodenal ulcer once (836 case), or twice (28) perforated is analysed. Recurrency of a perforative ulcer after its closure was noted in 1.4% of cases. After closure of a perforating ulcer, it is expedient to watch and examine the patients in a specialized institutions. In disease recurrency after closure of a perforative ulcer and ineffective therapy, the performance of radical operation preventing the subsequent development of a disease complication is indicated.

The posterior truncal and anterior proximal seromyotomy were performed in 150 patients. One and three years after the operation, 102 of the patients were examined. An excellent and good results were noted in 86.3%, a satisfactory one--in 13.7% of the patients. No unsatisfactory result was noted. The given modification has the following advantages: rapid elimination of the pain syndrome, low traumaticity, technical simplicity and short duration of the operation.

The results of treatment of 438 patients with a perforating gastric and duodenal ulcer are presented. The use of emergency +gastroduodenal fibroscopy for early diagnosis permitted to reduce the incidence of diagnostic errors from 7.1% to 0. The indications for different types of operations have been established. Of the methods for gastric resection, a method with creation of +terminal-lateral +gastroduodenal anastomosis developed in the clinic is preferable. The excellent and good long-term results after closure of a perforative hole were noted in 11.7% of the patients, after vagotomy--in 91.6% after gastric resection--in 88%.

In a work, the peculiarities of clinical picture, surgical tactics and long-term results of the organ-preserving operations in 698 patients with duodenal ulcer disease operated on at the age under 30 years are analysed. It was established that the latent course and high incidence of acute complications manifesting the disease for the first time were the main peculiarities of duodenal ulcer in young patients. Vagotomy together with the other methods of surgical treatment of duodenal ulcer can be successfully used in young patients as an elective, or emergency surgical aid.