. Operative surgery, for students and practitioners . Fig. 95.—Plication of Gastro-hepatic Ligament (Beyea). 1, 2, and 3 indi-cate a single stitch of each of the three rows that are placed in the gastro-hepatic ligament as represented by the dotted lines. Gastroplication.—The folding in, or reefing, of a portion ofthe wall of the stomach in order to diminish the size of the operation was first performed by Bircher, and is especially ap-plicable to cases of dilatation without stenosis of the pyloric orifice. The abdominal incision, five to six inches in length, may beplaced a fingers
. Operative surgery, for students and practitioners . Fig. 95.—Plication of Gastro-hepatic Ligament (Beyea). 1, 2, and 3 indi-cate a single stitch of each of the three rows that are placed in the gastro-hepatic ligament as represented by the dotted lines. Gastroplication.—The folding in, or reefing, of a portion ofthe wall of the stomach in order to diminish the size of the operation was first performed by Bircher, and is especially ap-plicable to cases of dilatation without stenosis of the pyloric orifice. The abdominal incision, five to six inches in length, may beplaced a fingers breadth distant from and parallel with the left free 244 ABDOMEN AND BACK. border of the ribs, commencing above near the tip of the ensiformprocess, or it may be located in the linea alba, reaching from a pointone inch below the tip of the ensiform process downward as far asthe umbilicus. Through either of these incisions the stomach maybe brought out upon the abdominal Fig. 96.—Gastroplication. Lower border o£ the stomach is turned up andstitched near the lesser curvature with a single row of sutures (4), methodof Bircher; with four rows of sutures (1, 2, 3, 4), method of Weir. According to Bircher, the anterior wall of the stomach is foldedupon itself so that the greater curvature may be brought up closeto the lesser curvature and fixed in this position with a row of inter-rupted silk sutures; these should take a good, broad bite in the wallof the stomach, including its serous and muscular coats. Care shouldbe exercised that the sutures do not penetrate through the entirethickness of the wall of the stomach. Twelve to fourteen sutures areusually required. OPERATIONS UPON THE STOMACH. 245 According to Weir, the fixation may be made with three or fourseparate tiers of sutures, one superimposed upon the other. Afterthe stomach has been brought out through the abdominal incision,its anterior wall, corresponding to the long diameter of the organ, KAL
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