. A new manual of surgery, civil and military. which may have been collected, and to demonstrate the fact that theunion between the stomach and jejunum is perfect. In doing the anterior gastro-enterostomy it is wise to add Ilartmannssuggestion of stitching the intestine to the stomach wall an inch above theproximal side with a mattress suture. A second suture is placed in samemanner about one inch on the distal side of the anastomosis. This preventsthe jejunum from kinking on the gastro-jejunal opening. it is again important to select the lowest point in the stomach, in order tosecure perfect
. A new manual of surgery, civil and military. which may have been collected, and to demonstrate the fact that theunion between the stomach and jejunum is perfect. In doing the anterior gastro-enterostomy it is wise to add Ilartmannssuggestion of stitching the intestine to the stomach wall an inch above theproximal side with a mattress suture. A second suture is placed in samemanner about one inch on the distal side of the anastomosis. This preventsthe jejunum from kinking on the gastro-jejunal opening. it is again important to select the lowest point in the stomach, in order tosecure perfect drainage of this organ, and especially for the purpose of pre-venting the flow of bile from the duodenum into the stomach. It is alsoimportant to remain as great a distance from the diseased portion of the organ SURGERY OF THE ESOPHAGUS AND STOMACH 485 as is compatible with securing the most dependent portion; fortunately, thelatter usually lies very well to the left. In patients who are greatly reduced in strength it is well to reinforce the. Gastro-Exterostomt. Anterior gastro-enterostomy. The jejunum being united to the stomach at its lowestpoint, which will prevent the regurgitation of bile, vicious from Dr. W. J. Mayos original drawing. Murphy button to a certain extent by the use of a cuff formed out of theomentum, as shown in the plate. It has occasionally happened after a gastro-enterostomy in greatly reducedpatients, that a sudden motion, such as would be experienced during a severeparoxysm, of coughing, sneezing or vomiting, would be followed by a looseningof the anterior portion of the union between the stomach and the intestine. 486 SURGERY OF THE ESOPHAGUS AND STOMACH In these cases it is wise to enforce this union by employing the omentum, whichis always well nourished and abundantly supplied with blood vessels, and willconsequent!} make up for the deficiencies in the nutrition of the stomach wall. Non-operative cases. In case an operation is refused
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