Cancer of the stomach; a clinical study of 921 operatively and pathologically demonstrated cases . apposition. It is well now to make a straight incision through theperitoneum and muscle down to but not through the mucousmembrane of the stomach wall between the two fine-toothedclamps which have been applied, and also between the twofine-toothed clamps on the wall of the jejunum. Theincision will mark the location of the gastro-enterostomyopening. A fine, silk suture threaded in an ordinary cambricneedle is ased to unite the serous surfaces. The thread 434 CANCER OF THE STOMACH should be about
Cancer of the stomach; a clinical study of 921 operatively and pathologically demonstrated cases . apposition. It is well now to make a straight incision through theperitoneum and muscle down to but not through the mucousmembrane of the stomach wall between the two fine-toothedclamps which have been applied, and also between the twofine-toothed clamps on the wall of the jejunum. Theincision will mark the location of the gastro-enterostomyopening. A fine, silk suture threaded in an ordinary cambricneedle is ased to unite the serous surfaces. The thread 434 CANCER OF THE STOMACH should be about 75 cm. long and should be used double soas to prevent slipping and twisting. It is well to beginthis suture at a point opposite the distal end of the gas-tro-enterostomy clamp and to make the sutures so that theserous surface will be in perfect coaptation, leaving a fairmargin of 2 or 3 mm. between this row of sutures and theedge of the incision. This row of sutures is carried 3^ the end of the incision. The needle and thread arethen placed to one side for future use. A fine, double. Fig. 90.—Row of Connell catgut sutures being applied. chromicized catgut suture, the surface of which has beenrendered smooth by rubbing with vaseline is next employedas a deep suture. This suture is begun at a point oppositeto the conclusion of the serous suture in order that the knotsof this suture may not be opposite the knots of the silksuture previously described. This suture is carried intothe lumen of the small intestine, then across the edge ofthe incision taking a bite of about 1 mm. of the small in-testine and the stomach so that it includes all of the layersof both structures. The first suture is tied and then acontinuous suture is applied with the stitches near enoughto each other to absolutely prevent hemorrhage. Thissuture is carried to the distal end of both incisions and then SURGICAL TREATMENT OF CANCER OF THE STOMACH 435
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