Modern surgery, general and operative . of Senn or by simple suturing,or else effect side-to-side junction by the method of Abbe or of Moynihan.^ Local Intestinal Exclusion.—This operation was introduced by Salzerin 1891. It excludes the fecal current from a portion of the intestine. Incomplete exclusion the intestine is cut through above and belo^v the diseasedportion, and the ends of the healthy gut are united to each other or the endof one portion of gut is implanted into the side of the other. Both endsof the excluded portion may be fastened to the skin, making a double fistula(Von Eiselsb
Modern surgery, general and operative . of Senn or by simple suturing,or else effect side-to-side junction by the method of Abbe or of Moynihan.^ Local Intestinal Exclusion.—This operation was introduced by Salzerin 1891. It excludes the fecal current from a portion of the intestine. Incomplete exclusion the intestine is cut through above and belo^v the diseasedportion, and the ends of the healthy gut are united to each other or the endof one portion of gut is implanted into the side of the other. Both endsof the excluded portion may be fastened to the skin, making a double fistula(Von Eiselsberg); the distal end or the proximal end alone may be fastened tothe skin, the other end being closed by sutures and replaced within the abdo-men. Sometimes each end is closed and dropped back, and a fistula is madein the middle of the excluded portion to permit of drainage. Some operatorsclose each end by suture and drop them back, and do not drain the excludedportion; and others aim at the same end by suturing together the two ends. Fig. 717.—Operation of complete exclusion of the cecum: a and h, Lines of incision; / is implantedinto c; e and d are sutured to the abdominal wall. of the excluded part. It seems wisest to suture both ends, or at least one endto the skin (LeDentu, in Rev. de Gyn. et de Chir., Jan. and Feb., 1899).It is true this makes a permanent fistula, but if it is not done, the loop maybecome distended with secretion containing virulent bacteria, a conditionwhich may lead to perforation and death. Exclusion is rarely performed uponthe small intestine. It is best suited to the large intestine. If it is done atall, complete exclusion is the best operation (Fig. 717). Partial exclusion israrely satisfactory. Exclusion has been performed instead of colostomy incases of intestinal obstruction, but it is best suited to inflammatory areas ortumors, irremovable because of adhesions or some other cause. After theoperation the diseased area may improve because of d
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