Modern surgery, general and operative . and to a distance of 3 inches from the wound. Strips of gauze are passed,when possible, below the appendix to prevent entrance of infected material intothe pelvis, and a piece is pushed upward toward the liver (Van Hook). Overthe packing gauze, which it may be necessary to leave in place after the opera-tion, other pads are packed. The appendix is sought for by finding the colon is found by following the parietal peritoneum with the finger. Thecourse of the finger is first outward, next backward, and finally inward; the firstobstruction it enco
Modern surgery, general and operative . and to a distance of 3 inches from the wound. Strips of gauze are passed,when possible, below the appendix to prevent entrance of infected material intothe pelvis, and a piece is pushed upward toward the liver (Van Hook). Overthe packing gauze, which it may be necessary to leave in place after the opera-tion, other pads are packed. The appendix is sought for by finding the colon is found by following the parietal peritoneum with the finger. Thecourse of the finger is first outward, next backward, and finally inward; the firstobstruction it encounters is the colon. The fact that it is the colon can beconfirmed by finding the longitudinal bands. The anterior longitudinalband leads directly to the appendix. Pass the finger down to the head of thecolon, find the appendix, usually posterior and internal, and lift it and the headof the colon into the wound. In many cases it will be advisable to deliver thehead of the colon from the belly (Fig. 626); in other cases this will not be. Fig. -Radical operation for appendicitis(Kocher). I074 Diseases and Injuries of the Abdomen necessary, in some it will not be possible. If adhesions exist, they must begently and carefully separated. Barkers method (Fig. 627) is a very satisfac-tory mode of removing the appendix. It is done as follows: Turn up a cuff ofperitoneum, pull down the other coats, ligate at the base, cut through the tube,let the musculomucous stump retract, and tie or suture the peritoneal cuff overthe stump. Another method, which is the one I usually employ, is as follows:Pass a ligature through the meso-appendix, as shown in Fig. 628, A, tie the liga-ture, and cut off the meso-appendix below the threads. Crush the stump of theappendix with strong straight hemostatic forceps. This divides the mucousmembrane, submucous tissue and muscular coat, and leaves the peritoneal coatundivided. Remove the forceps. Surround the appendix with a catgut ligatureand tie the lig
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Keywords: ., bookcentury1900, bookdecade1910, bookpublishe, booksubjectsurgery
