. A new manual of surgery, civil and military. in line. The Kocher clamp is now removed and any bleeding pointcaught and tied. SURGERY OF THE ESOPHAGUS AND STOMACH 493 The final suture, of silk or linen, is now introduced and made after the right-angled plan of Gushing. It is taken sufficiently far from the catgut suture lineto enable easy approximation of the sero-muscular layers without tension. Steps (d) and (c) can be varied sometimes to advantage. AVe have fre- , Stomach with Caecixoma of Ptloetjs. ShoTN-ing manner of applying forceps to duodenum and also ligation of less
. A new manual of surgery, civil and military. in line. The Kocher clamp is now removed and any bleeding pointcaught and tied. SURGERY OF THE ESOPHAGUS AND STOMACH 493 The final suture, of silk or linen, is now introduced and made after the right-angled plan of Gushing. It is taken sufficiently far from the catgut suture lineto enable easy approximation of the sero-muscular layers without tension. Steps (d) and (c) can be varied sometimes to advantage. AVe have fre- , Stomach with Caecixoma of Ptloetjs. ShoTN-ing manner of applying forceps to duodenum and also ligation of lesser showing lymph nodes usually involved and line of excision in early eases.(From original drawing of Dr. W. J. quently tied off the gastro-hepatic ligament and the superior vessels and atonce double clamped and divided the duodenum. By pulling upward on thestomach side the gastro-duodenal artery is easily caught, tied and divided,and the operation proceeded with as before. In a few cases we have begun onthe stomach side, ligating and dividing the gastric and left gastro-epiploie ves-sels first, then clamping, dividing and suturing the stomach as before, complet- 494 SURGERY OF THE ESOPHAGUS AND STOMACH ing the duodenal end with its vessels last. This is favored by Hartmann. Ifthere are adhesions, however, the first plan mobilizes the stomach much betterand enables more accurate work and greater exposure of that part of thestomach, which, at the line of sec
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Keywords: ., bookcentury1900, bookdecade1910, bookpublishe, booksubjectsurgery
