The aim. To analyze treatment approaches and tactics and improve acutely complicated duodenal ulcers (DU) treatment results. Materials and methods. The results of the analysis of the surgical treatment of acutely complicated duodenal ulcers (a combination of 3 and/or 4 combined complications) are presented for 2 periods: the 1st (2000–2014) years (group A) – 47 patients, the 2nd (2015–2021) years (group B) – 34 patients. Results. 81 (100 %) patients were operated on for acutely complicated duodenal ulcers, of which 68 (84.3 %) patients had a combination of three complications, and 13 (15.7 %) had four complications. Out of 81 patients, 72 had bleeding complications, which is 89.3 %. Complications of ulcer perforation – in 36 patients, 44.7 % of all other complications. Based on the obtained analysis data, there is a steady trend towards an increase in the share of organ-sparing operations (OSO) by 1.6 times (from 50.9 % to 81.4 %), a decrease in the number of gastric resections (GR) by 2.9 times (from 14.9 % to 4.9 %) and palliative operations (PO) by 3.2 times (from 15.8 % to 4.9 %) with a relatively stable number of performed organ-preserving operations (OPO): in group A – 17 (24 .6 %) interventions, in group B – 4 (21.1 %). Conclusions. The use of modern measures of endoscopic hemostasis made it possible to adequately prepare and operate on patients in the delayed period, and their share from the first period to the second increased by 2.9 times. The number of patients who underwent emergency surgery with ulcer perforation and bleeding as combined complications decreased in the second period compared to the first by 2.5 times, which is associated with the widespread use of modern proton pump inhibitors (PPIs) in the conservative treatment of DU. The number of complications and mortality of this cohort of patients also significantly decreased due to the use of endoscopic hemostasis methods, making it possible to stabilize and prepare patients on the operating table. According to the analysis results, it became known that the chosen active-individualized tactics and the use of developed algorithms for choosing the type of surgical intervention made it possible to achieve a stable level of postoperative mortality at 8.1 %.

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The aim is to improve the results of surgical treatment of patients with gastric malignant tumors, complicated by gastrointestinal bleeding, by developing and implementing in clinical practice a new treatment tactic. Materials and methods. The study was conducted on the basis of the Kyiv City Center for Emergency Care of Patients with Gastrointestinal Bleedings and at the Kyiv City Clinical Ambulance Hospital (Ukraine) for the period from 2010 to 2020. A comprehensive examination and analysis of reatment’s results of 140 patients with malignant gastric tumors complicated by acute gastrointestinal bleeding, which amounted to 2.2 % of all reated patients with gastrointestinal bleeding during this period. Results. Radical operations were performed in 97 (69.3 %) patients, palliative and symptomatic – in 43 (30.7 %). Comparing the frequency of complications in the two periods of treatment of patients, a decrease in the second period, compared with the first period, the frequency of complications from 27.2 % to 11.4 % due to a decrease of 1.8 times (from 68.8 % to 37,5 %) complications after emergencies and related fatalities from 36.4 % to 0 and 2.2 times (from 20.8 % to 9.6 %) the incidence of complications after early delayed operations with a decrease in frequency fatalities from 20.9 % to 18.2 %. Conclusions. Operations at the height of acute bleeding in patients with gastric cancer are too dangerous due to the high postoperative mortality. The optimal standard is the use of a set of minimally invasive methods of endosurgical hemostasis to stop active bleeding and prevent its recurrence and operate on patients in the early delayed period. Adherence to such tactics is expedient from the point of view of reduction of risk for a life of the patient and possibility of carrying out radical operations.

The aim of the research. Analysis of results and development of surgical tactics for the treatment of DU with multiple combined complications. Materials and methods. The results of the analysis of surgical treatment of duodenal ulcers with multiple combined complications (3 and 4 combined complications) for 3 periods are presented: 1st (1983–1995) (group A) – 77 patients, 2nd (2000–2007) years (group B) – 30 patients and 3rd (2008–2020) (group C) – 46 patients. Results. 153 patients (100 %) underwent surgery for complicated duodenal ulcer (DU), of which 130 patients (84.9 %) had a combination of three complications and 23 (15.1 %) had four complications. Bleeding complications were noted in 139 of 153 patients, accounting for 90.8 %, and ulcer perforation in 69 patients, accounting for 45.1 % of all other complications. Based on the obtained data of the analysis, there is a steady tendency to increase the proportion of organ-preserving operations (OPO) by 1.5 times (from 50.7 % to 76.2 %), reducing the number of gastrectomy (GR) by 3 times (from 14.5 % to 4.8 %) and palliative operations (PAL) 3.3 times (from 15.8 % to 4.8 %) with a relatively stable number of performed organ-saving operations (OSO): in group A – 17 (24.6 %) interventions, in group B – 4 (21.1 %), group C – 6 (14.3 %). Conclusions. The use of modern measures of endoscopic hemostasis allowed to operate on patients in the delayed period, and their share from the second period to the third increased 2.8 times. The number of patients who underwent emergency surgery with perforation of the ulcer as one of the complications decreased in the third period compared to the second by 2.6 times, due to the widespread use of PPIs in the conservative treatment of DU. According to the results of the analysis it became known that the chosen active-individualized tactics and developed algorithms for choosing the type of surgery allowed to achieve a stable level of postoperative mortality at 8.3 %.