. A manual of operative surgery . n the proximal side of thegrowth. A second clamp is then fixed near to the other, sothat when the stomach is divided no extravasation of its contentscan occur. Third Stage, Excision of the Diseased Parts.—The stomachis divided completely across between the two clamps with straightscissors, the line of sectionpassing obliquely upwardsfrom left to right. The freepyloric portion—held in theclamp—is now turned overtowards the left until thecommencement of the duo-denum beyond the growthis reached. The gastro-duodenal artery is here ex-cised and ligatured close toi
. A manual of operative surgery . n the proximal side of thegrowth. A second clamp is then fixed near to the other, sothat when the stomach is divided no extravasation of its contentscan occur. Third Stage, Excision of the Diseased Parts.—The stomachis divided completely across between the two clamps with straightscissors, the line of sectionpassing obliquely upwardsfrom left to right. The freepyloric portion—held in theclamp—is now turned overtowards the left until thecommencement of the duo-denum beyond the growthis reached. The gastro-duodenal artery is here ex-cised and ligatured close toits origin from the a clamp has not alreadybeen applied here, this is done, and the scissors now divide the duodenum at right diseased portion, after any part of the mesentery still attachedhas been severed, is then removed. Fourth Stage, Union of Stomach to Intestine.—If the duo-denal end can be brought without undue tension directly incontact with the severed portion of stomach, the two are directly. FIG. 57.—EXCISION OF PYLORUS, ETC. The position of the incision across the stomachwill vary according to the extent of thegrowth, and may include much more of thestomach than is here shown. 200 ABDOMINAL OPERATIONS [PART II united by suture. The two clamps are brought parallel to eachother and near together, a sufficient amount of stomach andduodenal wall protruding beyond each to allow of the suturesbeing introduced. The two sections will not correspond in size,that of the stomach being often considerably larger. As thesurfaces are linear it is easy to see how much of the stomachsection must be closed to make them correspond. The duodenummust be sutured to the lower portion of the stomach, startingfrom the great curvature. The superfluous part above is atonce closed by a continuous suture of fine silk which traverses all the coats. A similar con-tinuous suture is then madeto unite the duodenum to thestomach, leaving an openingthe full size of the f
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