TONY AMERY In 1897, the Swiss surgeon Carl Schlatter carried must use this knowledge and experience to select out the first successful total gastrectomy for gas­ the reconstruction procedure which will leave the tric cancer. Three years earlier, Haberkant of patient with the fewest postoperative problems. Danzig reported a mortality rate of 54.4% in a Currently, the tried and trusted Roux-en-Y re­ collection of 257 resections for gastric cancer. construction is the most favoured procedure, but Over the last 100 years there have been radical the search for a better alternative will continue changes in surgical care, which have produced and Dr. Metzgers study using the ileocolic seg­ massive reductions in the risks associated with ment both experimentally in the pig and in hu­ such procedures. The introduction of prophylac­ mans suggests that this stomach substitute could tic surgical antisepsis by Semmelweiss and Lister in the longer term be a better proposition.