An incision, parallel to the costal margin, is made until the rectus muscle is reached. The fibres of the muscle are split vertically and the peritoneum opened. The stomach is exposed and drawn out of the wound ; a small incision is made into the stomach, a tube introduced and fixed by a single catgut suture. The tube is then laid upon the stomach wall for a distance of 2 in., or rather more, and a gutter is made for it by raising up a fold on each side and stitching the folds over the tube. The tube then opens into the stomach in the same manner as the ureter opens into the bladder. The stomach is fixed to the abdominal wall by two or three sutures. Mikulicz and Helferich have shown that after the lapse of a few months the oblique passage for the tube becomes a direct one, the inner orifice lying behind the outer.

Gastrostomy Witzels Method

Fig. 25.-Gastrostomy. (Witzels method.)