. Manual of operative surgery. n the operation; by it the normalureteral valves or sphincters are retained and infection is prevented from as-cending the ureters. Several modifications of Maydls operation have beensuggested, but most of them merely complicate the technic. VI. Makkas Operation.—(Zentralblatt fur Chir., 1910, No. S3-) Toavoid the dangers of ascending infection inseparable from any method by whichthe ureters are made to discharge into a cavity containing faeces, Makkas ex-cludes the caecum from the rest of the intestinal tract, unites its cavityto the skin by means of appendicost
. Manual of operative surgery. n the operation; by it the normalureteral valves or sphincters are retained and infection is prevented from as-cending the ureters. Several modifications of Maydls operation have beensuggested, but most of them merely complicate the technic. VI. Makkas Operation.—(Zentralblatt fur Chir., 1910, No. S3-) Toavoid the dangers of ascending infection inseparable from any method by whichthe ureters are made to discharge into a cavity containing faeces, Makkas ex-cludes the caecum from the rest of the intestinal tract, unites its cavityto the skin by means of appendicostomy and at a later date implants theureters into the segregated caecum using the appendix as a vent for the escapeof the urine. The Operation.—Stage —Step —Open the abdomen by an incisionthrough the right rectus muscle. Step 2.—Examine the caecum. If the caecum cannot be pulled to themiddle line, mobilize it by incising the parietal peritoneum parallel and closeto its outer side. 678 OPERATIONS ON THE BLADDER X. Fig. S41.—Makkas operation {Makkas.) Separate the caecum by blunt dissection from its posterior connectionsexactly as in ca^cectomy but carefully preserve intact its blood supply. Step 3.—Divide the ileum close to the caecum and close both the distal andproximal segments of the gut, Fig. 841. Step 4.—Divide the ascending colon above the cacum and close both theproximal and distal segments of the colon. Step 5.—Make a lateralanastomosis between the proximal segment of ileumand the distal segment of the colon (or thesigmoid). Step 6.—Perform appendicostomy bringing theappendix out through a special opening. (Bringingthe appendix out through an opening made bysplitting the muscles of the abdominal wall asin the McArthur-McBurney operation would, itappears to the author, provide an excellentsphincter to the appendix.) If appendicostomy seems inadvisable or im-possible because of adhesions, small size of theappendix, etc., perform 7.
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