Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . y Walker in making lateral anastomosis. A purse-string suture THE ABDOMEN 661 is inserted and the opening in the bowel or stomach is made inside of anastomosis is then made, and the purse-string is pulled out. Thefirst half of the anastomosis suture is inserted before the openings are cut. These methods have the disadvantage that a redundant free edge ofbowel is left on each stump. These free ends hang as a constricting flap inthe lumen of the bowel and inc
Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . y Walker in making lateral anastomosis. A purse-string suture THE ABDOMEN 661 is inserted and the opening in the bowel or stomach is made inside of anastomosis is then made, and the purse-string is pulled out. Thefirst half of the anastomosis suture is inserted before the openings are cut. These methods have the disadvantage that a redundant free edge ofbowel is left on each stump. These free ends hang as a constricting flap inthe lumen of the bowel and increase the amount of scar tissue. Anastomosis by simple invagination, with mucosa to peritoneum may bedone with the rectum and in rectosigmoid anastomosis. The upper seg-ment is simply invaginated into the lower segment for a distance of to5 cm. (1 or 2 inches). A large rubber tube is placed in the bowel, one endabove the anastomosis and the other end in the rectum or projecting throughthe anus (Fig. 1326). The upper end of the rectum is sewed to the outerlayers of the sigmoid. Ultimately the mucous and serous coats become. Fig. 1329a.—Closure of Bowel Ends by Ligation Inside of the Bowel (Method of Maunsell.)The first half of the lateral anastomosis has been done, and the lateral bowel openingsmade. One stump has been inverted and tied; the other is about to be inverted by draw-ing through the guide ligatures with a long clamp. adherent. If the sigmoid end has not been incised longitudinally, it mayrequire to be cut later with scissors through the proctoscope to relievecircular contraction. Lateral anastomosis may be employed in the stead of end-to-end anas-tomosis or it may be done to accomplish short-circuiting or intestinal occlu-sion. As a substitute for the end-to-end operation, it possesses the advantagesthat (1) it has simplicity of application in some respects; (2) the hazardousmesenteric triangle is not involved; (3) the opening can be made sufficientlylarge to a
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectsurgery, bookyear1920
