124 



II. DIGESTION AND ABSORPTION OF FATS 



especially when the ends are brought out at a higher and at a lower point 

 on the abdominal wall. The length of the loop employed by Bosio and 

 Giaume, 601 for their quantitative studies was approximately 20 cm. The 

 chief objection to either the Thiry or the Thiry-Vella procedure is the in- 

 ability to prevent leakage of the intestinal contents from the opening. 

 Several modifications have been proposed to obviate this difficulty. Gumi- 

 lewski 602 employed two rubber balloons, one at each opening of the Thiry- 

 Vella loop. The first was inflated and served as a plug. The second bal- 

 loon was penetrated by a short rubber tube which permitted the filling and 

 emptying of the loop. 



Fig. 8. Different forms of the Thiry-Vella fistulas 



There are several disadvantages in the Gumilewski technic. In the first 

 place, a single balloon has a tendency to be sucked into or expelled from the 

 opening, due to the peristaltic waves which continue to occur in the intes- 

 tine after the preparation of the fistula. It is difficult to anchor balloons 

 sufficiently to ensure an effective seal. Second, the use of a short rubber 

 tube is complicated by the fact that fluid collects in segments of the loop, 

 which can be removed only with considerable difficulty. A disadvantage 

 of the original Thiry procedure is the tendency of the loop to prolapse 

 through the fistulous opening. Modifications of the Gumilewski technic 

 have been proposed by Nagano, 603 by Cobet, 604 and by White and Rabino- 



601 P. Bosio and C. Giaume, Pathologica, 20, 504-509 (1928). 



602 Gumilewski, Arch. ges. Physiol. (Pfiiiger's), 89, 556-592 (1886). 



603 J. Nagano, Arch. ges. Physiol. (Pfluger's), 90, 389-404 (1902). 



604 R. Cobet, Biochem. Z., 114, 33-57 (1921). 



