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December 1973

Type of Gastrojejunal Anastomosis and Duodenal Stump Blow-out

Arch Surg. 1973;107(6):916. doi:10.1001/archsurg.1973.01350240080026

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To the Editor.–The editorial "Whither Goest the Duodenal Stump Blowout" by Ward O. Griffen, Jr., MD, and the article "Lateral T-Tube Duodenostomy" by Dardik et al (Arch Surg 107:11, 89-90) suggest that "whether the [gastrojejunal] anastomosis is made with the use of the entire transected stomach (Pólya) or only a portion of it (Hofmeister) makes little difference in postoperative duodenal pressures" (and therefore in the incidence of duodenal stump blowouts).

I should like to disagree, despite the well presented experimental evidence to the contrary.

If the model of gastrojejunal anastomosis is observed, not only in the usual anteroposterior plane but also sideways, it becomes evident that the width of the anastomosis, that is, the width of stomach segment used, should be no greater than the functional diameter of the small bowel loop to be attached to it. Let us contemplate from a lateral view a Pólya-type anastomosis wherein the

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