GASTRO-GASTROSTOMY. — In this pro cedure an opening is made in each of the two gastric pouches, and a free com munication is established between them by the anastomosis of the opening. The operation is sometimes known as Wol fler's operation for hour-glass contrac tion of the stomach. It has been per formed in five cases, with one death re sulting. In gastroplasty a longitudinal incision is made in the constricted por tion between the pouches of hour-glass stomach; this incision is stretched at a right angle and sutured, as in the lleineke-Mikuliez operation of pylorop lasty. It has been successfully per formed in seven cases. Watson, of Bos ton, has performed the operation of gas tro-anastomosis in one case, by the fol lowing method: The pouches of the hour-glass stomach arc folded on the constricted portion as a hinge; the an terior wall of the stomach is incised to give access to the double septum between the pouches; an opening is cut in the double septum, which is then sutured, and the incision in the anterior stomach wall is closed. In case of adhesions fix ing either pouch, this method would, of course, be impossible. The three oper ations seem to be equally successful, and the one selected would depend entirely upon the conditions found in each case. Gastroplasty would perhaps be the simplest operation if the constriction was not great. In case of a narrow con striction connecting the two pouches gastro-gastrostomy or gastro-anastomosis would probably be more applicable, though the latter would be impossible in case of adhesions.
In hour-glass stomach gastro-anasto mosis as carried out by Wolfler is the . most rational and the safest. It estab lishes a broad communication between the cardiac and pyloric ends, and at the same time lightens the task of expelling food from the already dilated cardiac portion by the deep location at which the anastomosis is established. For the last reason especially it is to be preferred to resection and pyloroplasty, with the establishment of the anastomosis nearer the small curvature. J. Hochenegg (Wiener klin. Woch., May 26, 'OS).
Gastrotomy.—The term "gastrotomy" has sometimes been used to designate an incision into the abdomen, but ordinarily it is used to mean an incision for opening the stomach.
The operation is performed for the re moval of foreign bodies from the stom ach; for the relief of stricture of the for exploration in case of doubt as to pathological conditions within the stomach; and as a prelimi nary to certain operations,—for in stance, Loreta's method of divulsion for stricture of the pyloris or in per forming gastro-anastomosis by method.
Exploratory gastrotomy has been per formed in a considerable number of cases in order to determine the diagno sis of pathological conditions, such as hemorrhage arising from erosion of the arteries or small ulcers, incipient car cinoma, polypi of the mucous mem brane, and other obscure conditions in which no positive diagnosis could be reached by other means. In most cases the diseased condition has been found and treated and recovery has thus far followed in every case. The slight danger from the operation and the certainty which it gives as to the cause of trouble makes the operation thor oughly justifiable.
Instead of proceeding for months in treatment by medication of obscure gas tric troubles an exploratory operation should be undertaken. In this way car cinoma of the stomach could be discov ered sufficiently early in many cases to allow of removal, which would probably result in permanent cure. This procedure has been recommended by Kocher and Keen. Certain cases of apparently purely functional disturbances have, in some way, been relieved by exploratory opera tion. Ernest Maylard (Lancet, Apr. 8, '99).
Gastrotomy for the 'removal of foreign bodies is indicated when there is severe or continued pain or discomfort present, whether accompanied with nausea, vom iting, and hemorrhage or not. It is also indicated for the removal of such for eign bodies as cannot pass through the intestinal tract or can only pass with great risk. Sharp or jagged bodies, such as bits of glass, pins, knife-blades, etc., have often been well tolerated by the stomach. Concretions of smaller bodies —such as fish-bones, cherry-stones, date stones, pebbles, and masses of hair sometimes give symptoms requiring their removal. As a rule, any concrete sub stance the size of which allows it to pass the cardia will pass the pylorus without difficulty; but this is not true of long bodies.