218 Anatomy Applied to Medicine and Surge* y. 



malignant growths confined to this part, or in cicatricial 

 stenoses that cannot be dealt with by pyloroplasty. In it 

 the pylorus is exposed through a median abdominal inci- 

 sion, the omental attachments of the part are divided be- 

 tween ligatures and the pylorus removed, care being taken 

 to avoid the important structures behind it, viz., the aorta, 

 the inferior vena cava, the portal vein, etc. The wound in 

 the stomach is then reduced to a suitable size and the 

 divided ends of the duodenum and the stomach are united 

 by Lambert's sutures or by Murphy's button. Gastro- 

 enterostomy is indicated when, in a case of pyloric stenosis 

 which cannot be relieved by pyloroplasty, the passage of 

 food from the stomach to the intestine is prevented. In 

 this operation an artificial channel is made connecting the 

 stomach to the jejunum, the anastomosis being secured by 

 sutures or by the Murphy button. Gastrectomy, or re- 

 moval of the stomach, may be employed for malignant 

 growths entirely limited to the stomach, and was first 

 performed by Schlatter, of Zurich, in 1897. It may be 

 done by dividing the omenta between ligatures and 

 then removing the organ by incisions through the duo- 

 denum and the oesophagus, and, lastly, approximating 

 these structures by means of sutures, or the button, as in 

 the other operations, above referred to. 



G astro plication, introduced by Bircher in 1891 and 

 improved upon by Wier, is for the purpose of reducing the 

 size of a dilated stomach, and is performed by folding the 

 wall on itself and retaining it there by Lambert's sutures. 



Gastrorrhaphy, or anchoring the stomach in gastrop- 

 tosis or downward displacement of the organ, is perform- 

 ed by suturing the ligaments of the liver to the abdominal 

 parietes (Treves, 1895) ; or, by uniting the peritoneal coat 

 of the stomach to the abdominal incision (Duret, 1896) ; 

 or, the lesser omentum to the peritoneum near the ensi- 

 form cartilage (Davis, 1897). 



