Operative surgery, for students and practitioners . -tents into the short or proximal arm of the gut, which becomes dis-tended and with the result that the contents back up and overflow backinto the stomach. In order to avoid the occurrence of this vomiting—vicious circle—a lateral communication is made between the twolimbs of the coil of intestine which has been attached to the may be done either at the same time that the gastro-jejunostomyis performed, or, since this regurgitation, etc., do not occur in all cases,it may be done later as a secondary operation, waiting for the app
Operative surgery, for students and practitioners . -tents into the short or proximal arm of the gut, which becomes dis-tended and with the result that the contents back up and overflow backinto the stomach. In order to avoid the occurrence of this vomiting—vicious circle—a lateral communication is made between the twolimbs of the coil of intestine which has been attached to the may be done either at the same time that the gastro-jejunostomyis performed, or, since this regurgitation, etc., do not occur in all cases,it may be done later as a secondary operation, waiting for the appear-ance of symptoms indicating the necessity of the additional operation OPERATIONS UPON THE SMALL INTESTINE. 445 before submitting the patient to the additional risk. It is probably«ise to do this entero-anastomosis at the same time as the primarygastro-jejunostomy, as it occupies but a few minutes additional secondary entero-anastomosis may be made with suture, clamps,Murphy button, or McGraws rubber suture, etc. The communicatioa. Fig. 206.—Jaboulay and Braun Modification. A lateral anastomosis has beenestablished between the two arms of the loop of jejunum. The arrow indicatesthe opening through which contents may escape from one arm of the gut intothe other. between the two limbs of the loop of gut should be made at their mostdependent part. For the details of the operation of lateral intestinal anastomosiswith the simple suture, clamps, McGraw rubber ligature, etc., thereader is referred to the description of these various procedures asthev are given elsewhere in this volume. 446 ABDOMEN AND BACK. Posterior Gastro-jejunostomy (von Hacker).—The jejunumis sutured to the posterior wall of the stomach, which is made access-ible through an opening torn in the transverse mesocolon. Asoriginan}^ employed a loop of the jejunum, twelve to fourteen inchesfrom its commencement, was anastomosed to the stomach. Theoperation was followed in man}^ cases by the phenome
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