. A manual of operative surgery . FIG. 63.—ROUXS Y METHOD OF GASTROJEJUNOSTOMY. CHAP. Ill] GASTRO-J E J UNOSTOM Y 215 stomach and of the other into the side of the jejunum. Somesurgeons bring up a loop of jejunum, make the communicationbetween it and the stomach, and in addition a lateral anasto-mosis between the two sides of the loop (afferent and efferentportions). We believe that the simplest method gives the bestresult, and the fear of a vicious circle being established is ground-. FIG. 64.—COMPLETION OF OPERATION. The distal portion of jejunum (a) is implanted irto the back of the
. A manual of operative surgery . FIG. 63.—ROUXS Y METHOD OF GASTROJEJUNOSTOMY. CHAP. Ill] GASTRO-J E J UNOSTOM Y 215 stomach and of the other into the side of the jejunum. Somesurgeons bring up a loop of jejunum, make the communicationbetween it and the stomach, and in addition a lateral anasto-mosis between the two sides of the loop (afferent and efferentportions). We believe that the simplest method gives the bestresult, and the fear of a vicious circle being established is ground-. FIG. 64.—COMPLETION OF OPERATION. The distal portion of jejunum (a) is implanted irto the back of the stomach (s), whilst theproximal portion (b) is implanted into the side of the former. less provided that the surgeon is careful to join the very com-mencement of the jejunum to the stomach in the mannerwhich has been described. Prof. Kocher, in 1903, suggested an interesting modifica-tion with the view of preventing return of bile, etc., intothe stomach after gastrojejunostomy. In several cases hehas divided the peritoneum above and to the right of the 2i6 ABDOMINAL OPERATIONS [part ii first part of the duodenum, and so been able to push inwardsthe latter sufficiently to establish the opening between the stomachand the duodenum above the orifice of the bile duct. The methodis for obvious reasons hardly likely to be applicable to manycases of gastric cancer or ulcer. The very elaborate plastic operation on the pylorus devisedby Finney, an American surgeon, appears to us hardly
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