. Manual of operative surgery. rough the meso-sigmoid above the partwhich has been ligated and divided but do not include any vessels within thesutures. Tie the sutures. This partly closes the peritoneum and it fixes thegut so that it cannot retract upwards (Fig. 645). 500 THE RECTUM Step 7.—Apply rubber-covered intestinal clamps to the gut above andbelow the lines chosen for division of the intestine. Lay the clamps along sideeach other and unite the anterior surfaces of the two loops of gut by a rowof continuous Lembert sutures on the tumor side of the clamps. Apply crush-ing clamps to the t
. Manual of operative surgery. rough the meso-sigmoid above the partwhich has been ligated and divided but do not include any vessels within thesutures. Tie the sutures. This partly closes the peritoneum and it fixes thegut so that it cannot retract upwards (Fig. 645). 500 THE RECTUM Step 7.—Apply rubber-covered intestinal clamps to the gut above andbelow the lines chosen for division of the intestine. Lay the clamps along sideeach other and unite the anterior surfaces of the two loops of gut by a rowof continuous Lembert sutures on the tumor side of the clamps. Apply crush-ing clamps to the two loops of gut between the line of Lembert suture andthe neoplasm. Divide the gut and remove the neoplasm. The crushing clampsprevent escape of contents from the gut being removed. Complete the end-to-end anastomosis of the gut (circular enterorrhaphy) (Fig. 646). The an-terior and part of the lateral surfaces of the gut are usually covered by peri-toneum if the tumor is fairly highly placed and hence good serous apposition. Fig. 646.—.Vnastomosis of gut. (Frousi.) can be attained. The posterior surface is devoid of serosa and hence union is lessaccurate. Proust therefore recommends that no attempt be made to coverthis portion of the intestinal wound by gliding flaps of parietal peritoneumover it, but that the parietal peritoneum should be stitched to the gut in suchfashion as to close the peritoneal cavity and leave the doubtful portion ofthe intestinal wound entirely extraperitoneal. If the tumor is found at toolow a level to permit of safe end-to-end anastomosis the operation may befinished by Mayos method. Step 8.—Bring the edges of the skin wound together with stitches deepenough to catch up the subjacent tissues. Drain all dead spaces with loosegauze packing. Remove the purse-string suture which closed the anus tem-porarily. Apply dressings. Keep the patient constipated during one week. PRELIMINARY COLOSTOMY 50I Inguinal Colotomy as a Preliminary to Excision oj the
Size: 1264px × 1978px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1920, bookpublisherphila, bookyear1921
