Operations for non-malignant disease of the stomach : report on 334 cases ... / by B.G.A. Moynihan.
- Moynihan, Berkeley Moynihan, Baron, 1865-1936.
- Date:
- 1907
Licence: In copyright
Credit: Operations for non-malignant disease of the stomach : report on 334 cases ... / by B.G.A. Moynihan. Source: Wellcome Collection.
Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.
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![No. First Operation Result Second Operation I Posterior gastro- enterostomy with Laplace forceps. Return of symptoms. Gastroenterostomy with Murhpy's but- ton. 2 Posterior gastro- enterostomy by su- ture. Regurgitant vomiting. Lateral anastomo- sis. 3 Same. Hernia into lesser sac. Reduced; lateral anastomosis. 4 Same. Return of symptoms. Loop found; later- al anastomosis. 5 Same. Same. Opening too small; gastroenteroplasty 6 Same. Constant vomiting. Gastrolysis; no re- lief. 7 Same. Same. Roux's operation; relief. 8 Pyloroplasty. Return of symptoms. Posterior gastro- enterostomy. 9 Same. Same. Same. The following is a complete tabulation of the 248 operations: f Simple suture ... i , ^jj(-g]-;gj- Roux's operation 2 Gastroenterostomy. i ti ■ Simple suture ... 211 - } Posterior. ^ Murphy's button i 1^ Laplace forceps . 3 Pyloroplasty 3 Gastroduodenostomy, Finney's operation 2 Gastropexy 2 Gastroenterostomy and gastropexy i Gastroenterostomy and gastrostomy i Infolding of ulcer alone i Excision of ulcer alone i Secondary operations. First operation by other sur- geons 10 Secondary operations. First operation by myself ... 9 248 In four cases in the above list, other opera- tions were performed at the same time as the gastroenterostomy. These were: radical cure of a right inguinal hernia in one case, ovariot- omy for large cyst in one case, hysteropexy in one case, appendicectomy in one case. All these patients recovered. Ajter-results. In this complete series there are four patients who are no better. In one, the condition found was a contracted stomach with extensive perigastritis. There are reasons for considering the condition syphilitic. The last report was that the operation had not made much difference. In two cases where no ulcer was found at the operation, the patients are in almost the same condition as before; the patients are neurot- ic, and operative treatment has certainly not helped them in the least. In one of these cases, gastroenterostomy had been performed by another surgeon; the symptoms — haemateme- sis, melaena, and pain —■ were not relieved by the operation. I operated a second time, but found nothing abnormal, and I therefore closed the abdomen without doing anything further. The symptoms still persist. In one case a large ulcer on the lesser curva- ture adherent to the liver was found. This patient has, after temporary marked improve- ment, relapsed, and is probably to be operated upon again. In addition, there are ten cases which must be separately mentioned. In three, the ulcer was on the lesser curvature, close to the cardia, with adhesions to the under surface of the left lobe of liver and diaphragm. These patients are all better since the operation; two of them have gained one and one half stone, but all of them complain still of occasional pains, some- times severe, radiating upwards into the chest. In one of these, pyloric obstruction also was present, due to a second ulcer. In one, the patient, who gained over three stone after the operation, has lost almost two stone of this increase, and has to restrict her food almost entirely to semi-solids and fluids. In three cases where no ulcer was found, and gastroenterostomy performed, some benefit has resulted, but there has been no pronounced improvement in the patient's health such as we are now accustomed to expect after gastro- enterostomy. In two cases the patients suffer from the occasional painless vomiting of pure bile. In other respects, the condition of both patients is quite satisfactory; neither suffers from indigestion or discomfort of any kind after food; both eat well, and both have gained weight. In one case — a case of gastric and duodenal ulcer, where hyperchlorhydria was excessive — the patient improved very little after operation, and after some months suffered a relapse, in which a hemorrhage (melaena) occurred. At a second operation, performed elsewhere, ad- hesions were found around the jejunum, on the](https://iiif.wellcomecollection.org/image/b21521190_0007.jp2/full/800%2C/0/default.jpg)
