The operation of gastroenterostomy was first performed by Wolfler at the suggestion of Nicoladini on September 28th, 1881. The patient, who was suffering from cancer of the pylorus, lived for four months.
For some years later so little confidence was placed in this and other operations on the stomach, that cases were, as a rule, treated medically until almost moribund before surgical treatment was considered advisable, with the result that the mortality was appalling. For instance, between 1881 and 1885 the mortality of gastroenterostomy was 65.7 per cent. There is, however, a very different statement to make toelay, when one can point to a personal experience of a series of nearly 300 posterior gastrojejunostomies, undertaken for both simple and malignant disease, with a mortality of only 3.4 per cent, and to a series of nearly 200 cases in which the operation was performed in my private practice for ulcer and its complications, with a mortality of only 1.5 per cent.
These and similar results by other surgeons bring the procedure well within the realm of safety, and seeing that it has to be undertaken in many cases for diseases that would be otherwise inevitably fatal, it may be looked on as an operation the benefits of which not even the most conservative practitioner can afford to ignore. These changes have been brought about, not only by patients being operated on at an earlier stage and under more favourable conditions-for many of my patients have been extremely ill at the time of operation-but also by greater care in technical details, by greater expedition in operating, by more careful asepsis, by the avoidance of, or greater care in, the use of irritating antiseptics, by the prevention or better treatment of shock, by care in post-operative treatment, such as early feeding subsequently to operation, and by the careful preparation of the patient.