. Operative surgery, for students and practitioners . affects the posterior wall of the stomachthan the anterior wall. Perforation due to ulcer, however, is morefrequently met with on the anterior wall. There may be more thanone perforation. The stomach should not be washed out beforeoperating if perforation is suspected. An incision is made in themiddle line through the linea alba from a point just below the ensi-form process to the umbilicus and the stomach exposed. The entire stomach should be carefully explored, first the ante-rior wall and then the posterior. In order to explore the poste
. Operative surgery, for students and practitioners . affects the posterior wall of the stomachthan the anterior wall. Perforation due to ulcer, however, is morefrequently met with on the anterior wall. There may be more thanone perforation. The stomach should not be washed out beforeoperating if perforation is suspected. An incision is made in themiddle line through the linea alba from a point just below the ensi-form process to the umbilicus and the stomach exposed. The entire stomach should be carefully explored, first the ante-rior wall and then the posterior. In order to explore the posteriorwall an opening may be torn, not cut, in the gastro-colic ligament orpreferably in some cases in the transverse meso-colon. Through theopening thus made access may be had to the posterior wall of thestomach. If the wound in the stomach is small, it may be closed with anon-penetrating purse-string suture or with a single row of Lembertsutures of silk. These sutures should take a good, broad bite in the \. ^t~~3* Y m 1 ? «?•? I S* J^m ?. Fig. 110.—Gastrostomy (Kader). Tube intro-duced through hole in stomach. The wall ofstomach is raised in two folds by four suturesthat have been inserted. Fig. 111.—Gastrostomy (Kader). Four suturesshown in Fig. 110 have been tied and two morefolds raised with four additional sutures.
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