Fig. 548
Rovsing’s operation for gastroptosis: V, stomach; V₁, position of the stomach before operation; U, urinary bladder; N, right kidney; A, B, C, silk sutures; x, x, scarifications. (Bergmann.)
Two procedures are now open to the surgeon: He may entirely close each of these openings with sutures and then make a posterior gastro-enterostomy, making new openings for this purpose, and by the common method described below, or he may reduce the size of the stomach opening and endeavor to fit it to that of the duodenum in such a way as to bring the two openings opposite each other, where they are then approximated as in ordinary end-to-end resection of the intestine. The earlier operation of Billroth and his followers was made according to the latter plan. It has been found usually easier and more successful to adopt the former method, as it is easier thus to prevent leakage and consequent infection; that is, the majority of operators would today probably completely close the stomach and the duodenum, and proceed at once to make a posterior gastrojejunostomy.
Fig. 549
Suspension of stomach by three rows of interrupted stitches through the gastrohepatic and gastrophrenic ligaments: 1, 2, 3, single stitches of the three rows. (Beyea.)
Fig. 550
Resection of the pylorus. Suture completed. (Richardson.)