Basil C. H. Harvey 219 
thus facilitating the passage of food into the duodenum. The anas- 
tomosis was 4 to 5 cm. long and was distant from the pylorus at least 
12 cm. on the stomach, and 20 em. on the duodenum. It is advisable that 
the gastric opening be distant at least 10 em. from the normal pylorus, 
in a dog of medium size, in order that it may be undoubtedly in the 
fundus region. In one animal one end of the anastomosis was inten- 
tionally disposed in the pyloric region about 6 cm. from the pyloric 
valve. 
More trouble was experienced in occluding the pylorus. After hgature 
with heavy silk its lumen was re-established in a month. Then the 
pylorus was plicated, so as to produce a longitudinal fold on its ventral 
surface. ‘The edges of this fold were united by a few fine silk sutures, 
and two ligatures of heavy silk were tied around the whole about 1 em. 
apart. After 10 months the lumen was partially established. The 
following method finally adopted was always successful. A longitudinal 
incision 2 to 3 cm. Jong was made on the ventral and another on the 
dorsal surface of the pylorus. They extended through the serous and 
muscular coats. ‘The mucous tube was then freed and cut across. The 
ends were closed with fine silk and pushed into the stomach and duo- 
denum. The edges of the wound were then pulled out laterally so that, 
while originally longitudinal, it became transverse. The edge in front 
of the stomach was then sutured firmly with heavy silk to that behind 
it, and the same procedure followed with the anterior and posterior 
duodenal edges. It is necessary that these sutures be made with heavy 
silk and that a large piece of tissue be included, because of the powerful 
contraction of the m. sphincter pylori. By this method the continuity 
of the vascular and nervous structures at the margins of the pylorus are 
preserved. 
The dogs were killed at stages after the operation of 2, 4, 7, 9, 12, 14, 
and 15 days, and of 1, 2, 3, 4, 514, 6144, and 10 months. The stomach 
was opened and the condition of the anastomosis and pylorus noted. 
The area of the anastomosis selected for study was that farthest removed 
from the pylorus in order to be sure to avoid the intermediate region. 
In one case which will be especially described later, material was taken 
from the pyloric end of the anastomosis also. This was the case in which 
one end of the anastomosis was actually in the pyloric region. For 
the study of the results following occlusion of the pylorus the material 
was selected from the center of the pyloric area. The changes occurring 
in the duodenum were not especially studied. Search was made, how- 
15 
