. American practice of surgery ; a complete system of the science and art of surgery . the pylorus sufficiently far to insure the removal of all invaded tissueand at least 3 cm. beyond this. This operation is the same, in every detail, as an operation for carcinomaof the pylorus, with the exception that, when a positive diagnosis of carcinoma 368 AMERICAN PRACTICE OF SURGERY. of the pylorus has been made, the mass of tissue removed extends farther to the left. Technique of the Operation.—The peritoneum covering the upper end of theduodenum is torn at the point at which the forceps {a, Fig. 133
. American practice of surgery ; a complete system of the science and art of surgery . the pylorus sufficiently far to insure the removal of all invaded tissueand at least 3 cm. beyond this. This operation is the same, in every detail, as an operation for carcinomaof the pylorus, with the exception that, when a positive diagnosis of carcinoma 368 AMERICAN PRACTICE OF SURGERY. of the pylorus has been made, the mass of tissue removed extends farther to the left. Technique of the Operation.—The peritoneum covering the upper end of theduodenum is torn at the point at which the forceps {a, Fig. 133) is intestine is then grasped in the bite of the forceps. A second pair of forceps(6) and a third pair (c) are then applied in an opposite direction, as close toforceps a as possible. In Fig. 133 these forceps are not placed as near each otheras they should be. Forceps a is then removed, and the intestine is severedthrough the middle of the bite of the jaws of this instrument. This leaves athin ribbon-like band of tissue projecting from both forceps h and forceps Fig. 134.—Diagram Showing the Relations of the Parts after the Completion of the RodmanOperation. The anastomosis has been established between the pylorus and the jejunum. S, Stomach;L, liver; g, gall-bladder; e, c, remains of omentum; d, duodenum; p, pancreas; j, jejunum; Col, colon. The portion projecting from forceps h is turned to the left and covered with agauze pad. A purse-string suture, d, is then appHed to the duodenum belowforceps c, and the projecting ribbon from the bite of forceps c is grasped by threeor more fine forceps (not shown in the diagram). Forceps c is removed and acatgut ligature is applied to the duodenum in the groove left after the removalof the instrument. The projecting ribbon-like tissue, together vAlYi the catgutligature, is now inverted into the lumen of the duodenum, and the purse-stringsuture d is tied. A few interrupted Lembert sutures complete this portion of the
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectsurgery, bookyear1906
