Operative surgery, for students and practitioners . through sutures of fairly heavy silk which are placedin the upper and in the lower end of the incision. After the through-and-through sutures have been introduced the two suspension suturesof catgut that secure the gut are tied and finally the through-and-through sutures are tied. The edges of the skin are covered by rubber tissue and theincision packed around the tube with iodoform gauze. Permanent Entebostomy is made, usually, for the purpose ofintroducing nutriment in cases of inoperable cancer of the pylorus, Maydl operation may b
Operative surgery, for students and practitioners . through sutures of fairly heavy silk which are placedin the upper and in the lower end of the incision. After the through-and-through sutures have been introduced the two suspension suturesof catgut that secure the gut are tied and finally the through-and-through sutures are tied. The edges of the skin are covered by rubber tissue and theincision packed around the tube with iodoform gauze. Permanent Entebostomy is made, usually, for the purpose ofintroducing nutriment in cases of inoperable cancer of the pylorus, Maydl operation may be employed or the fistulous tract may beestablished according to the plan of Witzel, as described in gastros-tomy, by infolding a rubber catheter in the serous surface of the wallof the intestine. Jejunostomt, Maydl.—The formation of a jejunal fistula forthe purpose of feeding. The procedure is employed in those cases of OPERATIONS UPON THE SMALL INTESTINE. 415 inoperable malignant disease of the pylorus where a gastro-Jejunostomycannot be B Fig. 191.—Jejunostomy (Maijdl). The upper segment of the gut has beenanastomosed into the side of the lower segment. The end of the latter hasbeen fixed in the incision in the abdominal wall A-B. The arrows indicate direc-tion of the peristaltic wave. The abdomen is opened by an incision through the middle of theleft rectus, reaching upward from the level of the umbilicus for adistance of three or four inches. Through this incision the operatoris able to investigate the condition of the stomach, etc. 416 ABDOMEN AND BACK. The uppermost portion of the jejunum is sought for and drawnout of the incision. This part of the gut is found to the left of thebody of the second lumbar vertebra and may be identified by the factthat it is fixed within the abdomen and resists the efl^ort to draw it outof the incision. A loop of gut about 20 cm. distant from the commencement of thejejunum is selected, and, after it has been stripped between the
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