[Closure of duodenal stump in gigantic duodenal ulcers]

A new method for closure of a duodenal stump in gastric resection was applied in 39 patients with giant penetrating, stenosing, and bleeding duodenal ulcers. The duodenum was cut across, 1-2 cm above the lower border of the ulcer. The first row of sutures was applied between the posterior duodenal wall, inserting the needle through the lower edge of the ulcer, and the anterior duodenal wall. Then the needle was inserted into the cut edge of the wall through the submucosa and led out through the serous coat at a distance of 0.8-1.0 cm from the edge. After tying the ligatures, the first row of sutures and the crater of the ulcer were covered with a strand of the greater omentum, whose width was no less than the diameter of the ulcer, on a nutrient supplying pedicle. The second row of sutures was placed between the upper edge of the ulcer and the anterior duodenal wall through the subserosa at a distance of 1.0-1.5 cm from the first row of sutures. The ligatures in this case pass over the strand of the greater omentum. The third row of sutures is applied between the capsule of the pancreas and the anterior duodenal wall through the subserosa for peritonization.