A Bilroth type I operation is used for the treatment of chronic gastric ulceration. It is particularly effective for ulceration at the junction between the gastric body and antrum.
Firstly, the stomach is mobilized by division of the gastrocolic omentum and dissection of the mesocolon from the posterior wall. The duodenum is mobilized by ligating and dividing the gastroepiploic vessels, dividing the right gastric vessels and dissecting finely around it. It is then divided between crushing clamps.
The stomach is then further mobilized. It is drawn upwards and to the right while adhesions and the descending branch of the left gastric artery are divided. The gastroepiploic artery is ligated and the more distal short gastric vessels are divided.
A resection of two-thirds of the stomach is then carried out from 2cm below the end point of the divided left gastric descending artery on the lesser curve to the most distal divided short gastric vessel on the opposite side.
A new lesser curve is formed by continously suturing with catgut for half the distance along the distal stump of the remaining stomach. This suture line is the buried by an outer suture in the seromuscular layer.
Anastomosis entails drawing the stomach and duodenum together by firstly placing a continous seromuscular suture from the greater curve of the stomach to apposing posterior wall of duodenum. The lumen are now in close apposition so that continuous gatgut can be used to first close all posterior wall layers before passing anteriorly. Additional sutures may then be added to reinforce the seromuscular layer of the lesser curve-superior duodenal juncture before closing up.
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