. Modern surgery, general and operative. o the direction of the stomach- 1234 Diseases and Injuries of the Abdomen tide. This can be accomplished by having the proximal portion of gut to theleft, and the distal portion to the right. The operation is to be so performedthat after its completion the stomach contents pass into the distal portion ofthe gut, and intestinal contents do not tend to enter the stomach (see Fig. 748).In order to accomplish this Kocher hangs the intestine to the stomach wall insuch a manner that the proximal portion of the loop is posterior and ascending,and the distal po
. Modern surgery, general and operative. o the direction of the stomach- 1234 Diseases and Injuries of the Abdomen tide. This can be accomplished by having the proximal portion of gut to theleft, and the distal portion to the right. The operation is to be so performedthat after its completion the stomach contents pass into the distal portion ofthe gut, and intestinal contents do not tend to enter the stomach (see Fig. 748).In order to accomplish this Kocher hangs the intestine to the stomach wall insuch a manner that the proximal portion of the loop is posterior and ascending,and the distal portion is anterior and descending. The bowel is hung to thestomach by a continuous serous suture of silk, the ends of which are left intestine is opened by a curved incision, the convexity of which is down-ward. The stomach is opened so that the convexity of the cut is upward. - Thevalve-like portion of the bowel wall is sutured to the stomach below the inci-sion in that viscus. The two openings are well approximated by Fig. 755.—McGraws method of lateral anastomosis: The elastic ligature is introduced(Walker). Gastro-enterostomy is done by the same plan. Operation by McGraws Elastic Ligature (Figs. 755-757).—The elasticligature was introduced by Silvestri in 1862, and was first used in intestinalanastomosis by the same surgeon. McGraw perfected the operation in 1891.(See Dudley Tait, in Annals of Surgery, Feb., 1906.) The operation may beanterior or posterior. The intestine and stomach are sutured together byLembert stitches. The elastic cord, which is 3 to 5 mm. in diameter, is passedthrough the stomach and then the bowel, in the long axis of each, and is tightlytied, and the knot is fastened with a silk thread. Another row of Lembertsutures buries the elastic cord from sight. The cord cuts through in from forty-eight to seventy-two hours and makes the anastomosis. Thus the dangerof infection is greatly lessened, for when the anastomosis opening is forme
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