. Surgery, its principles and practice . entery close to the appendix and upto the caput coli with scissors. A puckering suture of Pagenstecher linen 784 SURGERY OF THE APPENDIX VERMIFORMIS. is now inserted around the base of the appendix; an overstitch shouldbe made with this at the mesenteric attachment, which has the doublepurpose of ligating the small mesenteric artery and approximating thetwo peritoneal layers of the mesentery, giving an uninterrupted peritonealsurface around the base of the appendix. The appendix is then clampedI inch from the caput coli (see Fig. 429) and a catgut ligat
. Surgery, its principles and practice . entery close to the appendix and upto the caput coli with scissors. A puckering suture of Pagenstecher linen 784 SURGERY OF THE APPENDIX VERMIFORMIS. is now inserted around the base of the appendix; an overstitch shouldbe made with this at the mesenteric attachment, which has the doublepurpose of ligating the small mesenteric artery and approximating thetwo peritoneal layers of the mesentery, giving an uninterrupted peritonealsurface around the base of the appendix. The appendix is then clampedI inch from the caput coli (see Fig. 429) and a catgut ligature is tied inthe groove made by the clamp. The appendix is then amputated justI inch distal to the ligature. The caput coli is held by two tissue forceps,one on the appendico-mesenteric side, the other opposite, the catgut liga-ture cut, and the stump inverted with a hemostat holding a needle theblunt end of which protrudes ^ inch; the purse-string suture is then tiedfirmly around the needle, at the same time withdrawing it. A continu-. FiG. 429.—Showing the Grooves in the Mesentery and Appendix as Produced by theClamp and Hemostat, with Ligatures Inserted, Preparatory to Ligation. ous Lembert suture of linen then approximates the peritoneum of thececum over the stump and extends over the cut surface of the mesentery(see Fig. 430), making a third line of support against leakage. The ap-pendix should always be ligated before embedding it, as fatal intracecalhemorrhage has occurred without this precaution (Hessert). Non-absorb-able material should be used for the purse-string suture, because, if cat-gut were used and the needle penetrated the mucosa, it would at once bedigested by the intestinal ferments and leakage occur. This has hap-pened, and with one of the best of operators. The cecum is then returnedinto the abdomen. If the appendix has not Iuptured and the mesenteryis not infiltrated, drainage is unnecessary, regardless of the quantity ofseropurulent (staphylococcus al
Size: 1896px × 1317px
Photo credit: © Reading Room 2020 / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1900, booksubjectg, booksubjectsurgery
