A METHOD OF CORRECTLNG THE STOMACH DILATATION

IN GASTROPTOSIS
BY R. J. BEHAN, M.D.
OF PITTSBURG, PA.
SURGEON, ST. JOSPHES HOSPITAL

IN the correction of an enlarged and dilated stomach the aim

heretofore has been to support the stomach in such a manner that its
fundus is raised so that the greater curvature would be nearly on a
level with the pylorus, and consequently permnit of better drainage. The
methods previously devised consisted of shortening the gastrohepatic
ligament, of attaching the omentum to the anterior abdominal wall, or
of attaching the stomach to the anterior abdominal wall by means of
adhesions.
The surgical principle of all these methods seems to be wrong in

FIG. 1.-The method of making the flaps of serosa. The dotted lines indicate the direction of the
tunnels and the manner in which they run under the serosa.

that the pathological state (the atony) causing the end lesion is not
corrected; only the end lesion (the ptosis) itself is affected. Two of
the end results of a gastroptosis are gastric dilatation and an abnor-
mally low position of the stomach. Both of these act in a vicious
circle, for because of the ptosis the pylorus is kinked and consequently
food and drink entering the stomach will not easily be extruded, and
will act as additional inciting factors to a further dilatation and ptosis.
The surgical corrective principle would be either to decrease the
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 R. J. BEHAN
size of the stomach or in some manner to render it functionally more
active. The first of these is accomplished by the operation I have
devised. The second will follow as a result of the first.
To test the harmlessness of decreasing the size of the stomach I
performed an operation embodying these principles on a dog, and the
results were remarkably good. The description of the method follows:

FIG. 2.-The flaps have been drawn through the tunnels. The sutures have been placed.

Dog Operation.-Abdomen opened. Stomach exposed and a flap of serosa

was freed from its anterior surface. The flap (¼2 inch wide) extended from the
lesser curvature downward obliquely toward the greater curvature and fundus

FIG. 3.-Operation has been completed. Figure does not show the plication in the gastrohepatic
omentum, which is also necessary to bring the stomach up into its normal position.
for about 3 to 4 inches (Fig. i.). This flap was then inserted in a reversed
direction through two flaps raised from the subjacent muscularis (Fig. 2).
The flap was then sutured in place. The raw surface was puckered in (Fig. 3)
and the wound closed.
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 -A

Fl G. 4.-The stomach before it was opened. The scar is seen at B. At this place it is also
to he noted that the omentum is drawn up to a considerable extent (about 1 inch) on the anterior
surface (C), thus narrowing the lumen to the same degree. Adjacent. to A is seen a raw area, to
which, hecause of certain later operative procedures, the abdominal wall had been attached. The
contractive power of the stomach must have been excellent, as even after death water is forced
with difficulty through the pylorus. The gastrohepatic omentum is plicated at the point A.

FIG. 5.-The lumenkof the stomach with its rug-is exposed. The large ruga (B) anterior to

cotrcIon of
The wll.e soahwthickened
the
AtAisse wal cxonsistin ofThe muclarisgTe
ruga
()ateirt

seem to be absolutely normal in appearance.

 STOMACH DILATATION IN GASTROPTOSIS
February 2I: The dog was very active and frisky, extremely playful. In-
cision 0. K.
March 23: Abdominal incision. The area of stomach operated showed a scar
somewhat T-shaped. No adhesions. Stomach much smaller than at time of
first operation. At the time of the first operation the lower border of the greater
curvature extended a considerable distance below the liver margin. At the
present the lower border extends only a very short distance below it.
On December I2, I9I5, the dog was killed, and the stomach removed. It
was remarkably decreased in size. On the anterior surface is seen the scar
resulting from the operation. On examining the internal surface of the stomach
the rugae are apparently not disturbed over the area operated. On examining
the wall it is seen that at the area of operation there is a very long ruga which
projects into the lumen of the stomach. The wall is greatly thickened.
The specimen shows that after the plication the muscle contracted and threw
the mucosa into deeper folds. Thus the same area of mucous surface is exposed
so that the food comes into direct contact with the same extent of mucous mem-
brane. To sight and touch the gastric muscle is absolutely normal.
Whether this method would act as well in a dilated stomach remains to be
proven. It is not dangerous. It is planned on physiologic principles, and the
stomach functionates perfectly after its adoption. However, in man it might be
necessary at the same time to plicate and thus shorten the gastrohepatic ligament.
NOTE.-Since the above went to press I have used this method on two patients
and so far the results have been very satisfactory.

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