Alternative methods for restoring gastrointestinal continuity after gastric resection for carcinoma

Abstract

The chief factors of safety in carrying out gastric resection for carcinoma are: (1) preparation of the patient for operation, (2) use of the most innocuous type of anesthesia, (3) complete removal of the diseased area of the stomach, (4) proper technic in the operation itself, (5) scrupulous cleanliness, (6) restoration of continuity following removal and (7) after care. The methods of reuniting the stomach and duodenum are: (1) anastomosis of the entire end of the stomach and the end of the duodenum, (2) closure of the end of the duodenum followed by anastomosis of the end of the stomach and the second portion of the duodenum, (3) closure of part of the end of the stomach and anastomosis of its open portion with either the end or side of the duodenum. Segmental resection is probably the simplest and safest method of removing a gastric cancer. Local excision alone for carcinoma of the stomach should be attempted only under exceptional circumstances. In by far the greater number of gastric resections, the Billroth II procedure or one of its modifications is the operation of choice. The general principles of anastomosis are based on general surgical principles: 1. 1. Hemorrhage should be controlled. 2. 2. Approximation should be accurate. 3. 3. Folds at the edge of the stomach should be avoided. 4. 4. There should be no tension from suture lines. 5. 5. Suture material should include some permanent suture, such as silk or linen. 6. 6. Resection should be done sufficiently far from the growth that anastomosis is made in healthy tissue. 7. 7. At the angles of anastomosis, approximation of the intestine and the stomach should extend well beyond the actual opening. Operation should be performed as early as possible in the course of the disease.