. Manual of operative surgery. reter with its vessels, up to the pelvic brim and downto the base of the broad ligament. Ligate the ureter with catgut close to the 726 EPISPADIAS bladder; apply a fine clamp to the ureter a little above the ligature; divide theureter between the clamp and ligature; cauterize the distal stump. Preparea fine catgut suture by threading each end on a fine needle. Pass the needlesfrom within outwards through the whole thickness of the ureteric wall and dis-tant from each other about one-third the circumference of the ureter. Wrapthe mobilized ureter and the catgut su
. Manual of operative surgery. reter with its vessels, up to the pelvic brim and downto the base of the broad ligament. Ligate the ureter with catgut close to the 726 EPISPADIAS bladder; apply a fine clamp to the ureter a little above the ligature; divide theureter between the clamp and ligature; cauterize the distal stump. Preparea fine catgut suture by threading each end on a fine needle. Pass the needlesfrom within outwards through the whole thickness of the ureteric wall and dis-tant from each other about one-third the circumference of the ureter. Wrapthe mobilized ureter and the catgut suture with needles still attached, in a padof gauze. 3. Pull the lowest part of the pelvic colon into the wound and apply longi-tudinally to it a fine intestinal clamp in such a manner as to segregate the anti-mesenteric edge of it for about 3 inches (Fig. 883). Make a very small cuttransversely through the gut wall down to but not through the mucosa atthe junction of the middle and lower thirds of the clamped-off portion. Make. Fig. 88s.—(Stiles.) a small opening through the mucosa. Pass the two needles of the uretericsuture through the mucosal wound and make them penetrate the wall of thegut from within outwards. Push the end of the ureter into the gut. Tightenand tie the catgut suture. With silk or hemp, suture two parallel folds of gutwall over the implanted ureter and the original catgut stitch in the Witzelmethod (see Gastrostomy). The stitches should pick up a sero-muscular foldon the side of the ureter but must not enter its lumen. Remove the intestinalclamp. 4. Suture the divided peritoneum on the floor and posterior wall of the pelviswith catgut, leaving a small opening at the uppermost part for the passage ofthe ureter. It is important to make sure that the portion of ureter whichpasses from the opening left in the peritoneum to the site of implantation shouldbe as short as possible, and it is with this object in view that the implantationin the pelvic colon is made
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