. Manual of operative surgery. on that the coronaryvessels and the distal divided end ofthe left gastro-epiploic vessels are en-circled by the stitch and the edges ofthe wound are everted (Fig. 518). Com-plete the closure of the stomach bymeans of sutures so introduced that thewound is everted, that is, mucosa tomucosa. Remove the clamp controlling the gastric circulation. If any bleed-ing occurs it must be visible and so easily controlled because the edge of thewound is slightly everted. The preferable suture material is chromicized the everted line of sutures by a continuous laye
. Manual of operative surgery. on that the coronaryvessels and the distal divided end ofthe left gastro-epiploic vessels are en-circled by the stitch and the edges ofthe wound are everted (Fig. 518). Com-plete the closure of the stomach bymeans of sutures so introduced that thewound is everted, that is, mucosa tomucosa. Remove the clamp controlling the gastric circulation. If any bleed-ing occurs it must be visible and so easily controlled because the edge of thewound is slightly everted. The preferable suture material is chromicized the everted line of sutures by a continuous layer of chromicized catgutsutures. Step 8.—Remove the rubber dam and gauze protection. Restore the organsto the abdomen. Close the abdomen. Codman claims for this operation that the lesser curvature can be re-moved up to the very edge of the oesophageal opening. By the use of a double-headed suture the flap made by the greater curvature is readily drawn completion of the gastro-enterostomy has been made with ease and the. ,f Fig. siS. GASTRECTOMY 38s usual difficulty of attaching the jejunum to the stump is avoided. But themain point is that unsuspected soft ulcers may be detected when the stomachis open. The presence of ulcers or of their sequelae is the most common occasionfor operations on the stomach. When ulcers are present, the lymph nodescorresponding to the diseased area are generally enlarged and form a goodguide to the location of the disease. Gastrectomy. Partial gastrectomy.—i. It is imperative to bury by sutureor better to excise by knife or cautery every duodenal ulcer which bleeds easilyor threatens to perforate. Hemorrhage is more common before operation ingastric than in duodenal ulcer, but hemorrhage subsequent to operation is morecommon in the case of duodenal ulcer. One cause of this pecuharity is undoubt-edly that the fear of malignancy has led more frequently to excision of thegastric ulcer by knife or cautery. The following tables from the Mayo Cl
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