. American practice of surgery ; a complete system of the science and art of surgery . ch below the lower limit of the groh. (Fig. 386.)The proximal end of the bowel is then grasped with intestinal forceps, its 920 AMERICAN PRACTICE OF SURGERY. aperture being thus closed, and dissected out from the hollow of the sacrumas high up as the promontory or further, if the removal of the entire growi,h,too-ether with any lymph nodes that may be involved, necessitates such a same precautions as have been described in the previous paragraphs areobserved with regard to tearing off or wounding of
. American practice of surgery ; a complete system of the science and art of surgery . ch below the lower limit of the groh. (Fig. 386.)The proximal end of the bowel is then grasped with intestinal forceps, its 920 AMERICAN PRACTICE OF SURGERY. aperture being thus closed, and dissected out from the hollow of the sacrumas high up as the promontory or further, if the removal of the entire growi,h,too-ether with any lymph nodes that may be involved, necessitates such a same precautions as have been described in the previous paragraphs areobserved with regard to tearing off or wounding of the superior hemorrhoidalor inferior mesenteric arteries. When the bowel has been sufficiently loosenedto bring it down without tension it is amputated about one inch above thetumor and sutured to the distal end by sutures passed from within outward, sothat the knots can be tied inside the bowel. (Fig. 387.) The slit in the anteriorwall of the bowel is closed in a like manner. After this, the laparotomy padsare removed; the peritoneum is closed by catgut sutures; and the vaginal. Fig. 383.—Sacral Anus, After Bone-flap Extirpation. (Tuttle: Diseases of tlie Anus, Rectum, andPelvic Colon. D. Appleton & Co., New York.) wall, together with the peritoneum and external sphincters, is reunited. Forthis part of the operation Murphy uses silkworm-gut sutures. (Fig. 388.) Adrainage tube is passed through the anus, above the point of anastomosis, andsutured in position. Owing to the fact that a large space is left behind the bowel after the re-moval of the cellular tissue, fat, and lymph nodes in the hollow of the sacrum,the writer modifies Dr. Murphys technique in the following manner: A circu-lar incision is made behind the anus and is carried through all the tissues intothe retro-rectal space. The rectum and the cellular tissues in this space areseparated from the sacrum, as high up as the growth extends, by the fingeror by a dull instrument. The rectum is then separated from its at
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectsurgery, bookyear1906
