Fig. 543
Gastroplication. When the threads a a´, b b´ are drawn up a fold is formed. (Bircher.)
Sectional view to show result of operation.
Operations for Gastric Ulcer.
—In dealing surgically with an ulcer of the stomach the selection has to be made between anastomosis and direct exposure of the stomach wall with the performance of a gastrotomy (i. e., opening the stomach) and then discovering the site of the ulcer, either treating it with the actual cautery, the curette, or, preferably, when this general method is adopted, completely excising the involved area and bringing the margins of the wound thus made together with sutures, which over the mucosa only may be of chromic gut. Should it seem advisable to excise the entire thickness of the stomach wall it would be better to suture in two layers, making the external one of thread or silk, while the inner one may be made of reliable chromic catgut. If this operation be attempted the incision into the stomach should be made sufficiently large to permit of thorough exploration. Nothing being found in the anterior wall, the gastrocolic omentum should be opened and the entire stomach palpated between the operator’s hands. Any suspiciously indurated spot on the posterior wall may then be so manipulated as to be brought into view through the anterior opening. Other surgeons besides myself have noted the occurrence of serious hemorrhage, which, upon exposure, must have come from small fissures or cracks in the mucous membrane. In fact the lesion which may furnish a considerable amount of blood may thus be so small and concealed as to be really difficult of exposure. However, exploration should be made as thoroughly as possible. The stomach having been opened and the ulcer found, it should be treated by one of the above methods. If, on the other hand, nothing be found the surgeon still has the measure of gastro-enterostomy. Any ulcer, however, which is threatening perforation can usually be recognized by the sense of touch alone, corroboration being afforded by inspection. An ulcer which is recognized and found to be favorably situated may be completely excised. It has been found, however, that this ideal measure of local attack gives but little better results than does the general procedure of gastro-enterostomy, while, on the other hand, it is less satisfactory in some respects and seems to be an equally if not more dangerous procedure.
Fig. 544
Fig. 545
Surface view of the result.