[The surgical treatment of stomach ulcers difficult to remove]

Experience in surgical treatment of 154 patients with large gastric ulcers and ulcers of the cardiac part of the stomach is discussed. All the patients underwent resection of the stomach in various modifications with a 2.6% mortality rate. Penetration was encountered in 62.4% of patients with large ulcers and in 69.2% of those with ulcers of the cardia. In 13.6% of patients with "difficult" gastric ulcers ligation of the main trunk of the left gastric artery becomes necessary, which may be the cause of incompetence of the gastrointestinal anastomosis in performance of tubular resection. Intraoperative angiotensiometry showed that in ligation of the trunk of the left gastric artery the intramural blood flow in the distal segment of the tubular gastric stump was reduced by one third. Preservation of the gastroepiploic arteries in mobilization of the stomach in this situation prevents ischemia of the gastric stump. The method of tubular resection makes it possible to avoid subtotal removal of the organ in most patients with gastric ulcers which are hardly removable and allows the Billroth I operation to be carried out.