Billroth's gastrectomy

Theodor Billroth, born on the island of Rügen in 1829, was called to head the second surgical clinic of the University of Vienna in 1867. He tested new operations on animals before trying them on patients: he removed the esophagus in dogs in 1871, performed a laryngectomy for cancer in 1873 and resected the cervical esophagus in 1877. He worked with only chloroform and ether for anesthesia, and with no intravenous fluids, transfusion or antibiotics.

Two surgeons had already tried to remove cancers of the pylorus. J. Péan's patient in Paris died on the fifth day after the operation in April 1879, and L. Rydygier's patient in Culm died 12 hours after surgery in November 1880.

Billroth's patient, Therese Heller, was 43 and the mother of eight. Since October 1880 she had lost a great deal of weight and had a swelling in the upper abdomen and frequent vomiting. On 29 January 1881, under a mixture of chloroform, alcohol and ether, with Mikulicz assisting, Billroth opened the abdomen, found a carcinoma of the pylorus involving more than a third of the lower stomach, tied the vessels along both curves of the stomach, cut out the tumor and sewed the duodenum to the remaining stomach. The operation took an hour and a half. A week later her wound had healed and she was eating semisolid food. She died of metastases four months after the operation.

Concerned that the cut end of the stomach was too wide for the duodenum, Billroth had his assistant Anton Wölfler try other techniques in dogs. On 14 January 1885 he first performed the variant later called Billroth II, joining the remaining stomach to a loop of jejunum, and he went on to use it in 32 patients. Wölfler's illustrated account of Billroth's pylorus resections was published in Vienna in 1881.