[Particular operations in surgery of gastric ulcer under the protection of vagotomy]

There are particular situations in the frame of the surgery of gastric ulcers, when the use of classical techniques--such as extensive resections, or sub-total resections--represents a risk factor and raising doubts about the vital prognosis of the patient (dehiscence, fistula, etc.). This is especially true for highplaced lesions, the removal of which supposes either an upper polar resection, or an almost total gastrectomy. This raises some problems with suture which are doubtful, as well as the risk of the "small stomach" syndrome or the risk of accelerated evacuation. The authors suggest several possibilities for the surgery of gastric ulcers under the protection of vagotomy, which allow a good immediate and late evolution. These include the medio-gastric resection, the so-called "saddle" resection, and the excision-suture resection, all being carried out under the protection of vagotomy associated to piloro-plastia. Making use of these procedures the authors have been able to maintain a more conservative attitude with regard to the stomach pouch, and to avoid some of the sequellae of the operated stomach.