[A method of suturing penetrating ulcers of the duodenal bulb].

The author developed a method for plastic treatment of the niche of a duodenal bulb ulcer, particularly when it is a source of profuse bleeding, when the ulcer is located on the posterior wall or penetrates into the head of the pancreas. The method is based on operation for bilateral subdiaphragmatic selective vagotomy and Finney's pyloroplasty. In performing the above procedure a pyloroduodenal spur is formed by a method modified by the author by making an incision through the pylorus closer to the lesser curvature of the stomach. As a result the formed pyloroduodenal spur is of a sufficient length and can be easily displaced into the bulb to the ulcer. The ulcer with the bleeding vessel is stitched through with Halsted's or Z-shaped sutures and the pyloroduodenal spur is sutured with the same sutures to the ulcer, effecting tamponade of its whole surface. When combined with selective vagotomy the method ensures reliable hemostasis. The method was applied with a favorable outcome in an 83-year-old patient followed up for 12 months.