Fig. 533
Gastrostomy by Frank’s method: suture of abdominal wound; stomach stitched in the skin incision. (Richardson.)
Cardiospasm.
—Operation for this condition consists essentially in a gastrotomy as above, the opening being made sufficiently near to the cardia in order that either with finger or with suitable dilating instrument passed upward from below, the contracted cardiac orifice may be stretched, or, if necessary, nicked at several points, and then forcibly dilated, in this latter procedure great care should be given that stress be distributed as much as possible. If it be practicable to introduce any dilating instrument a four-bladed uterine dilator would probably be ideal for the purpose.
Operations for Pyloric Stenosis.
—Among the earliest suggestions of a method of pylorodiosis was that of Loreta, who opened the stomach near the pyloric end and deliberately introduced through the constricted pyloric ring a dilating instrument, fashioned much after the shape of the ordinary glove stretcher, which, in fact, might be used for such a purpose should emergency require. The operation is simple and but slightly dangerous, but it was found that strictures here as elsewhere tend to contract, even after forcible dilatation, and that the method, while temporarily successful, was but seldom permanently so. It was applicable only to the cicatricial, i. e., the non-malignant cases.
A plastic method was then suggested independently by Heinecke and Mikulicz, with which their names are often connected and which is referred to as pyloroplasty. It consists essentially in making a buttonhole incision in one direction and then closing it in the opposite, as illustrated in [Figs. 534], [535] and [536].
Fig. 534
