CONNER,1 in 1884, probably performed the first total gastrectomy. Recently, total gastrectomy has been more frequently done for carcinoma of the stomach, especially for those lesions in the midportion of the stomach or higher. Lahey2 now advocates radical total gastrectomy for all operable carcinomas of the stomach and reports a decided increase in the three-year survival rate. The technic has been standardized; the management has become more physiologic, and the mortality rate has steadily decreased.
Certain disadvantages, related to nutritional deficiency, weight loss, anemia, and reflux esophagitis, are associated with total gastrectomy. Various modifications of the standard procedure of anastomosing the small bowel to the esophagus have been suggested to diminish some of these problems. Hoffman,3 in 1922, made a small stoma between the two limbs of the jejunal loop. This afforded a partial bypass of the duodenal contents and reduced the incidence of reflux esophagitis. Orr,