By far the most common cause of such adhesions is gastric ulcer, but they may result from a peritonitis or from inflam matory conditions involving neighbor ing organs, such as the colon, pancreas, spleen, liver, gall-bladder, or abdominal wall. Another cause is injury, whether operative or accidental.
0 peration. — Cceliotomy and division of the bands or breaking up the adhe sions is usually followed by perfect re lief. As haemorrhage sometimes results from the division of adhesions, it is best to cut band-like adhesions between liga tures when possible. The denuded sur face left by the separation of adhesions should be covered with omentum if pos sible to prevent their forming again. In certain cases of very extensive adhe sions, producing hour-glass contraction of the stomach or stenosis of the pylorus, gastroplasty or resection may be neces sary.
Gastroplication, or Gastrorrhaphy.— Gastroplication (this term being prefer able) is an operation which consists in making a fold in the stomach-wall and suturing it, for the relief of chronic dila tation. If the dilatation is due to malig nant pyloric stenosis, pyloreetomy, gas tro-enterostomy, or gastreetomy would be indicated instead of this operation. In dilatation resulting from non-malignant stenosis pyloroplasty would probably be the preferable operation. Gastroplica tion is thus mainly limited to the treat ment of those cases in which stenosis is not present and in which the dilatation is excessive.
opening the abdo men the anterior wall of the stomach is folded on itself by lifting up the greater curvature to the lesser curvature, and it is held in this position by two or more rows of sutures. Certain operators pre
fer the use of purse-string sutures. Sufficient time has not elapsed to deter mine definitely the permanent results of this operation, but the unanimous ver dict of those who have performed the operation is in its favor. Seventeen operations have thus far been reported, with only one death.
Gastropexy.—Oastropexy is the term used to designate the operation for fix ing the stomach to the anterior abdomi nal wall by suture. The operation has been performed for the relief of gastrop tosis, or sagging of the stomach (Gle nard's disease), which is with difficulty distinguished from dilatation. It has been successfully performed in three cases, but gastroplication or gastro enterostomy seems to be preferred in the majority of cases.
Gastro-gastrostomy, gastroplasty, and gastro-anastomosis are operations per formed for the relief of hour-glass con traction of the stomach.
The most common cause of hour-glass contraction of the stomach is due to adhe sions following gastric ulcer, but the con dition may be congenital or may be de veloped in adult life without any known cause. A differential diagnosis between this condition and obstruction due to pyloric stenosis is, in many cases, almost impossible, for the symptoms of these conditions are practically identical. If severe disturbances of digestion arise. as is often the case, one of these operations would be indicated.