Gastric resection with the de Petz mechanism

0 NE of the most intriguing chapters in a11 medicine is that phase of surgery which deaIs with the technic of performing gastric and intestina1 resections and anastamoses. The task has been a diffIcuIt one because of the nature of this Iong, potentiaIIy septic, thin-waIIed organ whose functions vary at different points. Many new methods and instruments have evoIved through the years, some of which have become indispensable procedures and others have faIIen by the wayside because of their awkwardness. These procedures may be pIaced into three groups: first, the hand method; second, the cIamp method; and third, the sewing mechanism. The sewing mechanism is the simpIest and in our opinion the most aseptic, hemostatic and rapid method yet deveIoped. The voIuminous, ever changing Iiterature on gastrointestina1 surgery is itserf evidence of the hit and miss progressive nature the soIution of the probIem has assumed. H. H. Kerr points out that the first mention of the technic of intestina1 surgery is in Lanfranks’ “Science of Cirurgie,” pubIished in 1396. In 1812, Benjamin Travers performed a research study showing that heaIing of intestina1 wounds was by aggIutination of the viscera1 peritoneum at the edges of the wound in the intestine to the peritoneum of adjacent viscera or to the parieta1 peritoneum. This agglutination theory had been known for 400 years but Travers showed it was not necessary to anchor the visceral and parieta1 peritoneum as it was previousIy thought. Antoine Lembert, in I 8 I 2, showed that intestina1 wounds hea by adhesion of the inverted peritonea1 coats and not by the adhesion of the adjacent cut edges. The foundation of gastric surgery was Iaid in 1875 by Gussenbauer and Winniwarter who first reported gastric resections in dogs. This work was suggested by BiIIroth who Iater was the first to perform successfuIIy a gastric resection on a human. Pean (I 879) and Rydygier (I 880) had previously attempted this on humans without success. In 1892, Murphy introduced stee1 buttons with which to approximate anastamoses. This was quite successfu1 and lent great impetus to the popuIarity of intestinal surgery. The great danger of the button Iodging in the stomach or smaI1 bowe1 and producing an obstruction is its main disadvantage. The Murphy button was replaced by the suture method and Kerr points out that up to 1923 there were aIready about 250 different suture methods in the last century. In Iike manner, a great number of cIamps have been devised to facilitate intestinal anastamoses but the onIy instruments of use in gastric resection have been the sewing mechanism type herein discussed. These instruments are the ingenuous resuIt of the surgeons’ desire to simplify gastric surgery, shorten the duration of the operation and minimize the spiIIing of gastric contents with compIete hemostasis. The de Petz instrument though reIativeIy new (1927) was evoIved over a period of thirty years. Michailoff, in 1897, first recommended the sewing machine stitch in plastic surgery and Quain appIied the stitch to gastric and intestina1 anastamoses in 1916. It was FIorian Hahn who, in 1910, first demonstrated an instrument for mechanica1 stitching of the stomach and intestines. This consisted of a stitching mechanism contained in a pIate-Iike struc-