. A new manual of surgery, civil and military. Kocher clamp is now placed from the tied gastricartery at Mikuliczs point of election, in an oblique direction, so as to save asmuch as possible of the greater curvature to Hartmanns point of election onthe greater curvature. The blades of this clamp should be covered with rubbertubing and the compression should be just sufficient to retain the tissues in itsgrasp. A second clamp is applied on the tumor side to prevent leakage. Thetissues between are severed with the Pacquelin cautery, one-quarter of aninch from the holding clamp, and as the tissu
. A new manual of surgery, civil and military. Kocher clamp is now placed from the tied gastricartery at Mikuliczs point of election, in an oblique direction, so as to save asmuch as possible of the greater curvature to Hartmanns point of election onthe greater curvature. The blades of this clamp should be covered with rubbertubing and the compression should be just sufficient to retain the tissues in itsgrasp. A second clamp is applied on the tumor side to prevent leakage. Thetissues between are severed with the Pacquelin cautery, one-quarter of aninch from the holding clamp, and as the tissues are divided several catch for-ceps are applied to the projecting stump to prevent retraction of some pari 492 SURGERY OF THE ESOPHAGUS AND STOMACH of the gastric from the grasp of the Kocher clamp. The pyloric end ofthe stomach, with the tumor guarded against leakage by the clamp at eachend, is removed. The cauterized stump projecting beyond the Kocher clampis rapidh sutured with a catgut button-hole suture, from the greater to the. >l>j:.l\^n WiiH . w,.., ,jy iVLOKI>. Showirg lines chosen in making pyloreetomy or partial gastrectomy by various surgeons.(From original drawings of Dr. W. J. Mayo.) lesser curvature, through all the coats of the stomach, and in the same mannerdirectly back, and tied at the starting jioint; this prevents hemorrhage as wellas leakage. The doubling of this form of suture holds the approximated edgesevenl} 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- , IIVU/O.
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Keywords: ., bookcentury1900, bookdecade1910, bookpublishe, booksubjectsurgery
