Selection of operation for concomitant gastric and duodenal ulcers.

In an attempt to determine the most appropriate procedure for surgical treatment of concomitant ulcers, gastric secretion and pathological findings were studied. Acid and pepsin secretion in concomitant gastric and duodenal ulcers was significantly higher than in case of gastric ulcer alone, and similar to the secretion seen with duodenal ulcer. Thus, vagotomy was considered an appropriate procedure. In terms of the depth, histologic activity and exposure of large blood vessels at the base of the ulcers, concomitant gastric ulcer involved serious lesions compared with concomitant duodenal ulcer, indicating that distal gastrectomy was required. Therefore, we recommend vagotomy and hemigastrectomy for concomitant ulcers, in order to preserve the physiological function of the stomach, as much as possible.