[Figs. 550], [551] and [552] give a fair idea of the procedure of end-to-end reunion. The edges of the mucosa should be united with chromic gut, the stitches being close to each other, to prevent leakage and to control hemorrhage from small vessels. The external sutures of silk or thread should be placed sufficiently deep to afford a strong bond of union, and, at the same time, to escape the mucosa. Some difficulty is met here, for the thin wall of the duodenum should be attached to the thick wall of the stomach, but with care it can be done. When the divided stomach end has been reduced or trimmed off in such a way as to leave only a portion to be matched with the duodenal opening, there is need for extreme care at the corners and angles of the suture margins, as here tearing of stitches or separation by tension, perhaps during the act of vomiting, are most likely to occur. [Fig. 553] indicates the first of the procedures above mentioned.
Fig. 551
Resection of the pylorus. This figure illustrates the method of fitting the duodenum to the stomach when the gap in the stomach is too large to fit the duodenum. (Richardson.)
Fig. 552
Resection of the pylorus. (The same as [Fig. 551]). Suture of the stomach to the duodenum completed. (Richardson.)
Fig. 553
Resection of the pylorus according to Billroth’s second method. (Bergmann.)