Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . in the anterior wall of the stomach and athird suture in the anterior wall of the duodenum (Fig. 1409). Theselast two sutures should be at points equidistant from the duodenal suture(about 12 cm.) and mark the lower ends of the duodenal and gastric incisionsrespectively. Traction is then made upward on the pyloric suture and down-ward on the two other sutures. The two folds are brought together and su- 744 SURGICAL TREA TMEXT tured as for lateral anastomosis with
Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . in the anterior wall of the stomach and athird suture in the anterior wall of the duodenum (Fig. 1409). Theselast two sutures should be at points equidistant from the duodenal suture(about 12 cm.) and mark the lower ends of the duodenal and gastric incisionsrespectively. Traction is then made upward on the pyloric suture and down-ward on the two other sutures. The two folds are brought together and su- 744 SURGICAL TREA TMEXT tured as for lateral anastomosis with a continuous suture. Silk is commonlyused (Fig. 1410). After the posterior suture has been completed and tied, the anteriorlayer of seromuscular sutures is inserted. This should be a row of inter-rupted mattress sutures which are not tied but hooked out of the way withan aneurism needle above and below (Fig. 1411). The incisions in the stomach and duodenum are then made. The openingplanned for should be about 10 cm. (4 inches) long. These are the sameincisions as for lateral anastomosis excepting that they are connected above. Fig. 1413.—Pyloroplasty. Operation of Finney. Fifth suture in process of application. at the pylorus (Fig. 1412). Hemorrhage is checked. The redundant mu-cous membrane is trimmed off. Ulcers are looked for and if present two edges of the spur are sewed together by a continuous through-and-through suture of catgut starting at the pylorus and continuing to thebase (Fig. 1413). From this point it continues to unite the front of theopening ending at the pylorus. (Finney omits this anterior suture.) Itshould be interrupted at intervals by a tie. Chromicized catgut is usedfor the suture which passes through the mucous membrane. The THE ABDOMEN 745 seromuscular mattress sutures are then tied completing the anastomosis(Fig. 1414). If a complete anterior through-and-through suture has notbeen applied there should be added to
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectsurgery, bookyear1920
