. A manual of gynæcology and pelvic surgery, for students and practitioners. Fig. 284.—Fecal fistula. Resection for. Side-to-side anastomosis. Closureof blind ends beyond rubber-covered clamps. Lembert stitch which buries it. Rubber-covered clamps arethen placed longitudinally on the free margin of the gut nearthe blind ends, and a continuous Lembert silk stitch appHedwhich approximates the peritoneal coats of the two loops of 638 POST-OPERATIVE COMPLICATIONS AND SEQUELS intestine close to the edges of the clamps. This suture shouldbe at least 5 cm. in length. Both loops of intestine are theno
. A manual of gynæcology and pelvic surgery, for students and practitioners. Fig. 284.—Fecal fistula. Resection for. Side-to-side anastomosis. Closureof blind ends beyond rubber-covered clamps. Lembert stitch which buries it. Rubber-covered clamps arethen placed longitudinally on the free margin of the gut nearthe blind ends, and a continuous Lembert silk stitch appHedwhich approximates the peritoneal coats of the two loops of 638 POST-OPERATIVE COMPLICATIONS AND SEQUELS intestine close to the edges of the clamps. This suture shouldbe at least 5 cm. in length. Both loops of intestine are thenopened i cm. in front of the suture line, and an inner layer offine chromic gut applied which passes through all the coatson both sides. The method of application is precisely thesame as for the inner row in end-to-end anastomosis; that is,the first half next the clamp is passed from the mucosa of oneside, through the entire thickness of the bowel wall of both sides,and emerges on the mucosa of the second Fig. 285.—Intestinal resection. Lateral anastomosis. Detail of method of in-serting Lembert stitch to bury through-and-through stitch. If this is begun at one end of the incision in the intestine,the stitch is reversed at the other end, so that intestinal mucosashows along the anterior suture line. Having reached thefirst end of the incision the suture is tied, and then tied againto the end left when the stitch was begun. After loosening theclamps, the original silk Lembert stitch is continued until itreaches the starting point, and having reached the startingpoint is tied and then tied again to the end of the suture leftat the beginning of the stitch. FECAL fistula: INTESTINAL RESECTION 639 The intestine is thoroughly cleansed and returned to theabdomen, and all gloves and instruments are changed for theclosure which follows. If there is the least doubt of the in-tegrity of the bowel at the point of anastomosis, a cigarettedrain is introduced down to, but not again
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