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September 1949


Author Affiliations

From the Department of Surgery, the Henry Ford Hospital.

Arch Surg. 1949;59(3):758-767. doi:10.1001/archsurg.1949.01240040766036

WHEN BILLROTH performed the first successful partial gastrectomy in 1881, he restored intestinal continuity by anastomosing the stump of the stomach to the end of the duodenum. He was, indeed, the father of gastric surgery; for all thirty-seven different methods (Polya1) of reestablishing the gastrointestinal tract after partial removal of the stomach are modifications either of his original operation, gastroduodenostomy (Billroth I), or his subsequent procedure, gastrojejunostomy (Billroth II, 1885). Contemporaries of Billroth followed his first technic or devised modifications of their own, but modern gastric surgeons have tended to practice some variation of the Billroth II operation. The swing away from gastroduodenostomy to gastrojejunostomy occurred because the latter proved to be a safer operation. The difficulty in end to end anastomosis of the stomach and duodenum is due chiefly to inequality in size of the openings. That this was a real problem in the early days of gastrointestinal