. Manual of operative surgery. ctomy).Ligate the left gastro-epiploic artery well to the left of the disease and of thelast of the glands in the great omentum if the disease is cancer. Divide thegreat omentum leaving attached to the stomach that portion containing lymph PYLORECTOMY 397 nodes. As the gastro-colic omentum is being divided it will sometimes befound that the avascular area which lies in the circle of the middle colic vesselsand the posterior layer of the mesocolic peritoneum is attached to the this is the case the attached peritoneum can be cut out and removed withthe gr
. Manual of operative surgery. ctomy).Ligate the left gastro-epiploic artery well to the left of the disease and of thelast of the glands in the great omentum if the disease is cancer. Divide thegreat omentum leaving attached to the stomach that portion containing lymph PYLORECTOMY 397 nodes. As the gastro-colic omentum is being divided it will sometimes befound that the avascular area which lies in the circle of the middle colic vesselsand the posterior layer of the mesocolic peritoneum is attached to the this is the case the attached peritoneum can be cut out and removed withthe growth. The opening thus made in the transverse mesocolon can beused later through which to make the gastro-jejunostomy (Mayo). Step 5.—Continue the division of the gastro-colic omentum towards theright so as to get below and to the right of the inferior gastro-duodenal lymphnodes situated below and to the right of the pylorus about the head of thepancreas (Figs. 527, 528, 531). Lift up the fat and glands from over the head of. Fig. 533.—Blood vessels tied, glands separated, crushing forceps in place, and also clampsto prevent leakage from part to bt removed. Upper left drawing shows stump of duodenumin crushing clamp with suture placed for closing. {Mayc.) the pancreas separating them from the curve of the duodenum but leaving themattached to the stomach and pylorus. During the above dissection the vesselsanastomosing with the branches of the superior pancreato-duodenal artery areexposed and tied. Continue the dissection until at least 2 inches of the in-ferior border of the duodenum is cleared and the gastro-duodenal artery isexposed in the groove between the head of the pancreas and the and divide the gastro-duodenal vessels. This permits thorough re-moval of the glands. Step 6.—If the gastric growth is adherent to the pancreas, shave oflF aportion of the pancreas leaving the shaved-oflF portion attached to the stomach. 398 THE STOMACH If the involvement
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