The Choice Of The Method Of Surgery For Combined Ulcers Of The Stomach And Duodenum

Abstract

The 30-year experience of surgical treatment of 354 patients with combined
gastric and duodenal ulcers is presented (type II ulcers according to Johnson H.D., 1965).
Every third patient (32.8%) had ulcers “difficult” for resection of the stomach, gigantic in
size, high in localization, multiple in number and their combinations. Recent features of
the typology of ulcers dictated the choice of method and volume of gastric resection,
performed, as a rule, in an atypical version.
Postoperative mortality after emergency operations was 13.04%, and after planned - 2.7%.
The choice of a method for surgical treatment of type II ulcers should be based on a set of
criteria for their typology: localization, size, number of ulcers, presence of “difficult”
forms of ulcers, penetration, signs of malignant transformation. In this situation, it is
necessary to perform atypical gastric resections (scalene, tubular, distal subtotal, proximal
subtotal).
The secretory activity of the stomach in type II ulcers is not the main one in the choice of
the method and scope of the operation, with the exception of cases (4.2%) of the
hyperantrovagal type of secretion. In such a situation, if it is possible to perform a distal
resection of the stomach, it is necessary to supplement it with a stem bilateral vagotomy.