. Surgery, its principles and practice . rim. It is well now to pass a thread under it to make traction on the 266 SURGERY OF KIDNEY, URETER, AND SUPRARENAL GLAND. duct. In this way the lower end of the ureter can be brought into viewand the point of the bladder be determined where the implantation isto be made. The ureter at its lowest point is next exposed by a longitu-dinal incision through the peritoneum, a ligature being then passed aroimdthis point. The ureter is squarely divided after a padded clamp or tem-porary ligature has been placed on the proximal segment. A longitudinalcut may th
. Surgery, its principles and practice . rim. It is well now to pass a thread under it to make traction on the 266 SURGERY OF KIDNEY, URETER, AND SUPRARENAL GLAND. duct. In this way the lower end of the ureter can be brought into viewand the point of the bladder be determined where the implantation isto be made. The ureter at its lowest point is next exposed by a longitu-dinal incision through the peritoneum, a ligature being then passed aroimdthis point. The ureter is squarely divided after a padded clamp or tem-porary ligature has been placed on the proximal segment. A longitudinalcut may then be made, as in the operation of ureteral invagination, tosecure a larger orifice. An incision is next made through the bladder,preferably on a metal soimd (No. 12 F.), as near as may be to the ureteralend. It is to l^e made progressively smaller from the peritoneum, leavingit smallest at the mucosa. Ureterovesical suture may next be made with the sound introducedinto the ureter to steady the parts. Interrupted catgut sutures approxi-. FiG. 140.—Vesical Plication after Ureteral Implantation. mating mucosa to mucosa are used. When the fixation has been accom-plished, the peritoneum is carefully replaced and fixed by suture. Thesewing of the ureter in the vesical wall can be more quickly accomplishedby invaginating it mto the vesical opening by means of catgut suturespassed through the ureter, through the vesical opening, and out throughthe bladder wall near the margm of the opening in the bladder. Whenthe sutures are tightened, the ureter is drauoi into the bladder. Tosecure the fixation, plication of the bladder wall may be made as in theWitzel operation of gastrostomy. If the ureter is too short for implanta-tion and excessive traction would endanger its circulation, the bladdermay be displaced upward by separating its attachments to the pubic devices have been introduced to facilitate the operation. Thebutton of Boari and the tube of Chalot are among them.
Size: 1736px × 1439px
Photo credit: © Reading Room 2020 / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1900, booksubjectg, booksubjectsurgery
