. Manual of operative surgery. is longer than that of the other, place the sutures farther apart in thelonger than in the shorter segment. Remove the clamps and repair any open-ings in the omenta. Transgastric Partial Gastrectomy.—If an ulcer exists on the posterior wallof the stomach and is adherent to the pancreas it may be possible to gain accessto it by penetrating both the gastro-hepatic omentum and the transversemeso-colon and then to divide the adhesions, excise the ulcer and close thewound in the stomach, W. J. Mayo has found it much easier in several casesto perform a transgastric ope
. Manual of operative surgery. is longer than that of the other, place the sutures farther apart in thelonger than in the shorter segment. Remove the clamps and repair any open-ings in the omenta. Transgastric Partial Gastrectomy.—If an ulcer exists on the posterior wallof the stomach and is adherent to the pancreas it may be possible to gain accessto it by penetrating both the gastro-hepatic omentum and the transversemeso-colon and then to divide the adhesions, excise the ulcer and close thewound in the stomach, W. J. Mayo has found it much easier in several casesto perform a transgastric operation as follows: Incise the anterior wall of thestomach by a vertical incision; note the extent of the ulcer and its adhesions;incise the posterior wall of the stomach from the inside around and close tothe ulcer. Remove the ulcer, if necessary shaving off a thin surface of pan-creas. This shaving of the pancreas is not so formidable as might be im-agined, because the inflammation which has made it adherent to the stomach. Fig. 524.—Transgastric excision of ulcer on posterior wall of stomach. has converted the adherent portion, to a large degree at least, into scar the posterior gastric wound by a row of serous sutures, then by a row ofthrough-and-through chromicized catgut sutures (Fig. 524). Close the anteriorwound in the stomach. Pylorectomy and partial Gastrectomy.—Pylorectomy is almost alwayssupplemented by a partial gastrectomy. The indications for its performanceare usually malignant disease or pyloric ulcer and its sequelae. Before opera-ting on the stomach especially for cancer, it is of great importance to have agood working knowledge of the anatomy of the region, a knowledge which thestandard textbooks on anatomy are careful not to give. The gastro-hepatic or lesser omentum may be divided into three parts:{a) a thick, strong portion running from the liver to the cardiac end of thelesser curvature and part of the oesophagus (gastro-hepatic ligamen
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