The operation of subtotal gastrectomy has reached a point of excellent execution as far as the technical aspects are concerned. It is generally agreed that in order to obtain a satisfactory result in ulcer one should resect at as high a level as possible technically. Moreover, in total abdominal gastrectomy it is certainly desirable to be able to work with exposure at a high level. This also applies in the operation of subdiaphragmatic vagotomy. In brief, any procedure in the region of the lower esophagus or upper stomach could benefit by better exposure. This is attested to by the fact that some authors have recommended splitting the sternum, while others recommend removal of the xiphoid.
It is generally agreed that the anatomical build of the patient plays a large part in the ability of the surgeon to get exposure for any particular operative procedure. Thus, in gastrectomy the patient with