Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . placed onthe segment to be removed in order to retain its contents. The clamps placed on the bowel ends to be joined should not be at rightangles to the gut but their tips should incline toward one another. Thebowel should not be divided at right angles to its long axis, but about 25 or45 degrees away from that. This means that as the cut surface is fartherfrom the mesentery, the more bowel is removed (Fig. 1298). This oblique 638 SURGICAL TREATMENT division of th
Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . placed onthe segment to be removed in order to retain its contents. The clamps placed on the bowel ends to be joined should not be at rightangles to the gut but their tips should incline toward one another. Thebowel should not be divided at right angles to its long axis, but about 25 or45 degrees away from that. This means that as the cut surface is fartherfrom the mesentery, the more bowel is removed (Fig. 1298). This oblique 638 SURGICAL TREATMENT division of the bowel makes a larger lumen, and guarantees better nourish-ment to the distal side. If 45 degrees are removed from each side this meansthat an angulation of 90 degrees is produced by the union. There is no dis-advantage in this. The mesenteric triangle is then cut on two sides up to the the intestine is divided, its ends are cleansed and covered, and thesegment of bowel and mesentery removed (Figs. 1299 and 1300). Soiledpads and cloths are removed, the hands are rinsed off, and a general cleaningup Fig. 1296.—Mattress-interlocking Stitch of of cutting one-half of the double stitch. Some surgeons prefer not to remove the mesentery, but to place the liga-tures close to the bowel and parallel with it, and then cut the mesenterybetween the ligatures and the bowel. After removal of the intestine andanastomosis, the redundant mesentery is folded over and stitched to theadjacent mesentery (Fig. 1301). Another method of dealing with the un-removed mesentery, which I have used with satisfaction, consists in splittingit down midway between the two bowel ends, and leaving it in the form of THE ABDOMEN 639 two triangular flaps, one connected with each segment. After the anasto-mosis, one mesenteric flap is placed on one side and the other on the otherside, and each is sutured to the flat surface of the mesentery as close to thebowel as possible (
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectsurgery, bookyear1920
