Modern surgery, general and operative . f locking stitches is passedthrough all the coats of the stitches are tied and a secondrow is passed and tied (Fig. 652).The clamp is removed and thestump is buried by Cushingsright-angled suture or Dupuy-trens suture. A gastrojejunos-tomy is then performed to theposterior wall of the portion ofstomach which remains. Such a patient is usually muchdehydrated, and if he is, salt solu-tion should be given intraven-ously during the operation, andan enema of warm salt solutionshould be administered every sixhours for several days after theoperation.
Modern surgery, general and operative . f locking stitches is passedthrough all the coats of the stitches are tied and a secondrow is passed and tied (Fig. 652).The clamp is removed and thestump is buried by Cushingsright-angled suture or Dupuy-trens suture. A gastrojejunos-tomy is then performed to theposterior wall of the portion ofstomach which remains. Such a patient is usually muchdehydrated, and if he is, salt solu-tion should be given intraven-ously during the operation, andan enema of warm salt solutionshould be administered every sixhours for several days after theoperation. Active stimulation isusually necessary and 8 oz. ofcoffee should be given by rectimiat the completion of the opera-tion. The patient must be placederect or semi-erect in bed as soonas the effects of the ether pass away. Twelve hours after operation begin to give small amounts of hot waterby the mouth. Nourish by the rectum from four to sLx days, when fluid foodmay be given by the mouth, starting w^th small doses of albumin-water, and,. Fig. 652.—Pylorectomy by the Mayo method:End of divided duodenum buried by a purse-stringsuture. Row of lock stitches inserted in stomachstump (Mayo). Gastrotomy 1085 if this is tolerated, giving dessertspoonful doses of peptonized milk everyhour. During 1912 the Mayos did 46 pylorectomies for cancer, with 5deaths (Report of St. Marys Hospital). They did 13 for ulcers and benigntumors without a death (Ibid.). If during the operation the pancreas iswounded the closed end of the duodenum is applied chrectly to the pancreaticwound, as Willy Meyer suggested (^Trans, of Am. Surg. Assoc, 1910).The anterior peritoneiun and adventitious sheath of the pancreas is thensutured to the anterior surface of the duodenum. This plan prevents leakagefrom the duodenum and pancreas (Wm. J. Mayo, in Annals of Surgery,August, 1913). Total Gastrectomy.—The entire stomach was first removed by Conner,of Cincinnati, in 1SS3. The first successful operation was perform
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