DEPARTMENT OF SURGERY. 
493 
the entire stomach is resected, the oesophagus is united to the 
pyloric portion of the duodenum (Fig. 16), but before it is re¬ 
sected the contents of the duodenum is worked back, and a clamp 
or temporary ligature applied ; the ends of the stomach can be 
ligated to prevent the escape of its contents into the cavity ; 
when these clamps and ligatures are applied, the stomach is re¬ 
sected and the cavity well irrigated and all haemorrhage arrested 
before any attempt is made to continue the w 7 ork. 
(cl) Anastomosis or Approximation (Fig. 16).—When the 
preceding steps are completed, the ends are united; and in do¬ 
ing so the operator must resort to such methods which, in his 
judgment, will give the best results. In case of the entire 
stomach being removed, the ends are united as in intestinal 
approximation ; if only the pylorus is resected, the pyloric 
portion of the stomach is united to the duodenum, and in such 
cases the intestine may be anastomosed with the stomach, as 
mentioned in the article on gastro-intestinal anastomosis 
(XXIV, No. 5.) 
After-treatment .—For the first four or five days no food 
should be given by the mouth, but the patient should be fed on nu¬ 
trient enemata. It is advisable not to give food that will.stimulate 
gastric peristalsis, for such an action will disturb the wound. 
If the entire stomach is resected, food requiring gastric digestion 
should be given in small quantities at first, and increased 
gradually ; but, if only a part of it is removed, food may be 
given per os much earlier than if a large portion or all of it is 
removed ; in all cases, however, the first food should be pepton¬ 
ized. The patient must be kept quiet for a period of eight or 
ten days, and allowed only moderate exercise thereafter for at 
least a month or six weeks. 
8. Gastrotomy .—In human surgery this is considered an old 
operation, which was performed as early as the 17th century 
for the purpose of removing foreign bodies from the stomach. 
In veterinary surgery the operation has been successfully per¬ 
formed on small domestic animals and ruminants. The indi¬ 
cations for the operation are the presence of foreign bodies in 
the stomach, and growths on its internal surface. Foreign bodies 
that enter the stomach can generally pass through the pylorus ; 
but long and heavy objects are often lodged in the fundus 
and cannot be removed without an operation. Small objects of 
a high specific gravity frequently collect in the stomach and 
interfere with gastric digestion ; and, in such instances, the only 
remedy is to operate. Tumors and nlcers located in the mucous 
