Stomach, 217 



the middle of which should be one inch below the line for 

 the inferior border of the liver, the fibres of the external 

 oblique will be divided at right angles to their course; 

 those of the internal oblique will be parallel to the line of 

 incision, while the transversalis will be cut transversely. 

 After the abdomen has been opened, the opacity and 

 smoothness of the surface, the faint pink color and the 

 thickness and stiffness of its walls, assist in identifying the 

 stomach (Treves). Farabceuf advises inserting the fin- 

 ger beneath the liver as far as the vertebral column so as 

 to feel the aorta, and then carrying it to the left, when a 

 fold the gastro-hepatic omentum will be felt, and on 

 following this fold downwards, the stomach will be lo- 

 cated. The transverse colon may be recognized and thus 

 differentiated from the stomach by its saccular dilitation, 

 by its muscular bands, by the thinness of its walls and by 

 the presence of the appendices epiploicae. In gastrostomy 

 by Witzel's method, the serous layer of the stomach is in- 

 folded by means of Lambert's sutures arranged in one or 

 more tiers over a tube as it lies against the wall of the 

 stomach, the end of the tube having previously been in- 

 serted into the viscus through a small opening. The 

 stomach is then sutured to the abdominal wound. By 

 this method leakage into the peritoneal cavity is avoided 

 and the stomach is opened at the time of the operation 

 rather than, as in other methods, by dividing it into two 

 steps, one for the suturing of the wall to the abdominal 

 parietes, and the other for the incision into the stomach, 

 Pyloroplasty is employed for the surgical treatment of be- 

 nign strictures of the pylorus and consists in a longitu- 

 dinal incision through the stricture and into the adjoining 

 healthy tissues of the stomach and duodenum. The re- 

 sulting wound is now sutured transversely, so as to in- 

 crease the diameter of the narrowed pylorus. Pylorec- 

 tomy is for the purpose of removing the pylorus in 



