. A new manual of surgery, civil and military. ddiscomfort following the operation and there has been no regurgitant vomit-ing, vicious circle after gastro-enterostomy. the anterior operation having beenemployed invariably and the lowest point having been chosen, the anastomosisbeing made directly above the gastro-epiploic artery. Technique. In gastro-enterostomy the following steps are taken: The ab-domen is opened in the usual manner. The transverse colon and the omentum are then drawn out through theincision and the jejunum is located a little to the left of the median line, just 476 SURGER
. A new manual of surgery, civil and military. ddiscomfort following the operation and there has been no regurgitant vomit-ing, vicious circle after gastro-enterostomy. the anterior operation having beenemployed invariably and the lowest point having been chosen, the anastomosisbeing made directly above the gastro-epiploic artery. Technique. In gastro-enterostomy the following steps are taken: The ab-domen is opened in the usual manner. The transverse colon and the omentum are then drawn out through theincision and the jejunum is located a little to the left of the median line, just 476 SURGERY OF THE ESOPHAGUS AND STOMACH where it passes through the mesentery of the colon. By lifting up the colon onecan always easily locate this intestine. It is preferable to make a posterior gastro-enterostomj- through a tear inthe transverse mesocolon, the beginning of the jejunum being united to thelowest portion of the stomach. The points of anastomosis on the stomach andthe jejunum are selected just the same as described in the Mayo-Moynihan. Enterostomy with McGraw Elastic Ligature. The primary Lembert suture in place.(From Dr. H. O. Walkers original drawing of Dr. Theodor McGraw^ operation.) operation previously mentioned. The jejunum and stomach are sutured to-gether with a running Lembert stitch for a distance of seven centimeters. A long needle armed with a McGraw elastic ligature is then passed into thelumen of the intestine, so that its points of entrance and exit are one-half the line of sutures at each end. The point of the needle is grasped withforceps, then the elastic ligature is stretched in order to decrease its caliberso that it will thoroughly fill the needle holes in the intestine when it is re-laxed after being drawn through. The same step is reversed in the stomach. SURGERY OF THE ESOPHAGUS AND STOMACH 477 A strong silk ligature is then placed between the two free ends of the elasticligature, which are then tied in a half knot. While these ends are
Size: 1535px × 1627px
Photo credit: © Reading Room 2020 / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1910, bookpublishe, booksubjectsurgery
