The seromuscular remnant is now closed by suturing together the edges of each of the two V cuts.In t h i s way a conical bag is formed ; it is about 7 cm. long, a good blood-supply enters its base, and the apex is formed by the junction of the two curvatures of the stomach (Fig. 389).The apex of the conical stump is inverted by three seromuscular purse-string sutures (Fig. 390). The third of these should be inserted not less than about 3 cm. from the pylorus because beyond this point the antral stump is not ' invertible ', being tethered at its base to the pyloric ring. If insufficient length of antrum has been retained and the conical stump is less than 6 cm. long, it may be difficult to insert the third suture without undue tension, and it should be supplemented or replaced by a series of interrupted sutures.At this stage the retained greater and lesser omenta become easily available for oversewing the stump (Fig. 391).It is advisable to use a stab drain in the right hypochondrium for a few days.The type of suture material seems to be unimportant ; interrupted and continuous catgut, silk, and linen thread have been used in different cases without any noticeable difference in results.
SUMMARYA simple technique to ensure sound primary healing of the antrum in Bancroft's operation is described.The operation consists of seromuscular inversion of a conical stump possessing good blood-supply.Closure of the antrum by this technique is based on standard surgical principles and primary healing may therefore be expected in every case.The method has been used without mortality or biliary fistula or any other complication in 23 cases and is recommended with confidence for the treatment of ' irremovable ' duodenal ulcer.I am grateful to my medical colleagues, Sir Daniel
