Chap, xvii.j ABDOMINAL VISCERA. 333 



muscles of the abdomen are cut through. In gastros- 

 tomy the stomach is not opened at the time of the 

 operation, but is merely secured to the wound, and a 

 few days are then allowed to elapse so that adhesions 

 may form. At the end of this time the viscus is 

 opened. Much difficulty is occasioned by the loose- 

 ness of the mucous membrane, which is apt to pro- 

 trude at the wound by reason of its great laxity. 



Resection of the pytorus. The pylorus is 

 frequently the seat of cancer. As a means of re- 

 lieving the patient of this fatal disease, Billroth and 

 others have removed the whole of the diseased 

 pylorus, and have then united by sutures the cut 

 ends of the stomach and duodenum and closed the 

 abdominal wound. The situation of the cancerous 

 pylorus within the abdomen varies considerably, as 

 the diseased part is very apt to shift its position. It is 

 often found to have sunk down by its weight to a 

 point below the umbilicus, and to have contracted 

 adhesions to adjacent organs. The usual incision is 

 oblique in direction, is about four or five inches in 

 length, and is commonly made across the middle line 

 just above the umbilicus. The diseased part has to 

 be isolated and the omental connections of the right 

 end of the stomach freely divided. The vessels that 

 are almost certainly divided are the pyloric, the 

 gastro-epiploica dextra, and the gastro-duodenal. The 

 cancer is excised, and the cut end of the duodenum 

 united to the cut edges of the stomach, so as to re- 

 establish the canal. The details of the operation are 

 very complicated, and need not be here more fully 

 dealt with, further than to say that since the section 

 of the stomach must be much greater than that of the 

 duodenum, the aperture in the former viscus is united 

 by sutures until the gap left is equivalent in calibre to 

 that of the divided duodenum. 



Other operations on the stomach. If a 



