. Manual of operative surgery. ANTERIOR GASTRO-ENTEROSTOMY 365 the portion of intestine selected for anastomosis, the name gastro-duodenos-tomy or gastro-jcjunostomy may be used. According to whether the gut is united to the anterior or to the posteriorwall of the stomach, the operation is designated anterior or posteriorgastro-enterostomy. Woljlers Operation.—Anterior Gastro-enterostomy.—The preparation of thepatient is the same as in exploratory gastrotomy. Step I.—Open the abdomen by an incision in or near the middle line, be-tween the umbilicus and the ensiform cartilage. The cut is about
. Manual of operative surgery. ANTERIOR GASTRO-ENTEROSTOMY 365 the portion of intestine selected for anastomosis, the name gastro-duodenos-tomy or gastro-jcjunostomy may be used. According to whether the gut is united to the anterior or to the posteriorwall of the stomach, the operation is designated anterior or posteriorgastro-enterostomy. Woljlers Operation.—Anterior Gastro-enterostomy.—The preparation of thepatient is the same as in exploratory gastrotomy. Step I.—Open the abdomen by an incision in or near the middle line, be-tween the umbilicus and the ensiform cartilage. The cut is about four Fig. 484.—Anterior gastro-enterostomy. (Mayo.) * Step 2.—Expose the small intestine by pulling the omentum upwards andto the left. Find the jejunum by the method described on page 366. Emptythe loop of gut and apply clamps to keep it empty. Step 3.—On the lowest possible point of the anterior wall of the stomachselect a spot for the stomach opening (Fig. 484). Pull this portion of stomachand the loop of jejunum out of the belly and protect the cavity with gauze an anastomosis between the stomach and the jejunum, using eithersutures or the Murphy button. The method of making the anastomosis isidentical with that employed in posterior gastro-enterostomy, page 368. Step 4.—Cleanse the field of operation. Put aside all instruments which 366 THE STOMACH have touched the mucosa. Inspect the line of union, and if necessary rein-force it with a few Lembcrt sutures. If the point of union causes the intestineto kink sharply, this may be remedied by a few stitches uniting to th
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