A manual of modern surgery : an exposition of the accepted doctrines and approved operative procedures of the present time, for the use of students and practitioners . the ex-ternal wound closed. In the other method a smallportion of the stomach is drawnout of the wound and the baseof this small finger-like processstitched to the parietal perito-neum. The rectus muscle is thensplit and the skin underminedwith the knife or by blunt dis-section. The diverticle of thestomach is then pulled throughthe opening in the rectus muscle liver and the costal cartilages,inch from the lower border ofthe liv
A manual of modern surgery : an exposition of the accepted doctrines and approved operative procedures of the present time, for the use of students and practitioners . the ex-ternal wound closed. In the other method a smallportion of the stomach is drawnout of the wound and the baseof this small finger-like processstitched to the parietal perito-neum. The rectus muscle is thensplit and the skin underminedwith the knife or by blunt dis-section. The diverticle of thestomach is then pulled throughthe opening in the rectus muscle liver and the costal cartilages,inch from the lower border ofthe liver. It is not necessary inthe modern methods ofgastrostomy to divide theoperation into two stages ;first sewing the stomachto the abdominal wall andopening it only after ad-hesion to the peritoneumhas occurred. The dangerof leakage into the perito-neal cavity at the time ofoperation and of escapeof food after operationis avoided by the methodof Witzel by which anoblique fistulous track ismade in the gastric wall;and by that of Frank, whodraws a portion of thestomach upwards under abridge of muscle and skinand makes the externala higher level than the Fig. Gastrostomy: Witzels method. Tube in posi-tion ; sutures ready to close abdominal wall.(Richardson.) GASTBOTOMY. 627 and under the bridge of the skin, to make its exit near the costal border,where the skin is incised. Here the process of stomach is stitched andthen opened to make the orifice for introduction of food. At first small quantities of peptonized liquid food are solid food may be masticated by the patient and then intro-duced through the fistule. Fig. 359. Fig. 360.
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