. American practice of surgery ; a complete system of the science and art of surgery . ted end of the bowelis restored to its position, the peritoneum is sutured from above, and the ab-dominal wound is closed. Weir (Journal of the American Medical Association, 1901) has modified thisoperation by first removing the tumor through the abdominal wound, theneverting the remaining portion of the rectum and dragging the sigmoid down 926 AMERICAN PRACTICE OF SURGERY. through this everted part, and finally fixing it there by needles thrust throughthe four walls at right angles to each other. The edges
. American practice of surgery ; a complete system of the science and art of surgery . ted end of the bowelis restored to its position, the peritoneum is sutured from above, and the ab-dominal wound is closed. Weir (Journal of the American Medical Association, 1901) has modified thisoperation by first removing the tumor through the abdominal wound, theneverting the remaining portion of the rectum and dragging the sigmoid down 926 AMERICAN PRACTICE OF SURGERY. through this everted part, and finally fixing it there by needles thrust throughthe four walls at right angles to each other. The edges of the bowel aretrimmed off even and sutured, the needles are removed, a drainage tube isinserted into the bowel, and the everted rectum is replaced in position. In thisoperation it is important to observe carefully the condition of the circulationin the proximal end of the bowel before one applies the sutures. Unless thereare spurting arteries when the bowel is divided, one had better cut it off higherup, and even to repeat the operation until such are found; or, if spurting arte-. FiG. 389.—Colorectostomy, after Kellys method. ries cannot be found, it will be better to bring the bowel out through the ab-dominal wall and make an artificial anus. The combination of the abdominal with the perineal and sacral methods(abdomino-perineal and abdomino-sacral methods) has been employed since1884, when Czerny did it in order to extricate himself from certain difficultiesin a sacral operation. Priority, in this operation, is attributed variously toGaudier, Chaput, and Challot. Some operators loosen the bowel and thetumor as far as possible from below, and then remove them through an ab-dominal incision; some loosen the parts as far down as possible, through theabdominal incision, then close the abdominal wound and extirpate the bowelfrom below; some attempt to bring the bowel down and unite it to the analorifice, or to the segment of the rectum which remains after resection has been S
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