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The Polya procedure, or a modification of it, is one of the safest and most widely used repairs after extensive gastric resections have been performed, whether for ulcer or cancer.
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The schematic drawing (Figure 1) shows the position of the viscera after this operation is completed, which in principle consists of uniting the jejunum to the open end of the stomach. The jejunum may be anastomosed either behind or in front of the colon. In the retrocolic anastomosis, a loop of jejunum is brought through a rent in the mesentery of the colon to the left of the middle colic vessels and near the ligament of Treitz (Figure 2). In the antecolic anastomosis, a longer loop must be used in order to pass in front of the colon freed of fatty omentum. If the resection has been done for ulcer to control the acid factor, it is important that the afferent jejunal loop be made reasonably short, since long loops are more prone to subsequent marginal ulceration. The jejunum is grasped with Babcock forceps and brought up through the opening made in the mesocolon, with the proximal portion in juxtaposition to the lesser curvature of the stomach (Figure 2). The abdomen is then completely walled off with warm, moist sponges. The jejunal loop is grasped in an enterostomy clamp and approximated to the posterior surface of the stomach adjacent to the noncrushing clamp by a layer of closely placed, interrupted 00 silk mattress sutures (Figure 3). This posterior row should include both the greater curvature and the lesser curvature of the stomach. Otherwise, subsequent closure of the angles may be insecure. The ends of the sutures are cut, except those at the lesser and greater curvatures, B and A, which are retained for purposes of traction (Figure 4). When the end of the stomach has been closed with staples, a noncrushing enterostomy clamp is applied several centimeters from the line of staples. This provides fixation of the gastric wall during suturing and in addition ...