Abdominal Operations, Volume 1

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Saunders, 1914 - Abdomen - 4 pages
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Page 251 - Then, after all the stitches have been placed and retracted, the incision is made in the shape of a horseshoe. The sutures should be placed far enough apart to give ample room for the incision. The gastric arm of the incision is made through the stomach wall just inside the lowest point of the line of sutures, and is carried up to and through the pylorus and around into the duodenum, down to the corresponding point on the duodenal side. Hemorrhage is then stopped. It is well to excise as much as...
Page 237 - In the first case the stomach was adherent to the under surface of the left lobe of the liver...
Page 247 - Kvide the adhesions binding the 363 pylorus to the neighboring structures, also free as thoroughly as possible the pyloric end of the stomach and first portion of the duodenum. Upon the thoroughness with which the pylorus, lower end of the stomach and upper end of the duodenum are freed, depends in large measure the success of the operation and the ease and rapidity of its performance.
Page 370 - Pagenstecher's suture, and the entrance of the tube into the bowel is further guarded by two pursestring sutures, one over the other. The top of the loop is fixed to the skin by one or two stitches and the wound closed. The patient can then be fed at once with some peptonised milk and brandy. The whole operation can be done in from fifteen to twenty minutes and with very little visceral exposure. Should the patient be too ill to bear the little extra time occupied by the short-circuiting, the tube...
Page 251 - This reinforces the posterior line of sutures, secures better approximation of the cut edges of the mucous membrane, and prevents the reunion of the divided intestinal walls. The anterior sutures are then straightened out and tied, and the operation is complete, unless one wishes to reinforce the mattress sutures with a few Lembert stitches.
Page 57 - A drain in the presence of infection is deleterious to peritoneal resistance, and should only be introduced to exclude more malign influences. Postural methods, unless destined to facilitate encapsulation, are both futile and harmful, as far as drainage is concerned. Peritoneal drainage must be local, and unless there is something to be gained by rendering an area extraperitoneal, or by making from such an area a safe path of least resistance leading outside the body, there is, aside from hemostasis,...
Page 56 - Primarily fibrinous, these adhesions become organised in a few days (three days in dogs). If the irritation persists, they become progressively more mature fibrous tissue. After irritation ceases, their disappearance depends principally upon a mechanical factor, — the ability of the involved surfaces to pull themselves or to be pulled loose.
Page 247 - ... from the suture just described in the pylorus. These second sutures mark the lower ends of the gastric and duodenal incisions respectively. They should be placed as low as possible, in order that the new pylorus may be amply large. Traction is then made upwards on the pyloric suture, and downwards in the same plane on the gastric and duodenal sutures.
Page 331 - ... vena cava. If we take into account the following advantages of gastrectomy as compared with gastro-enterostomy — that in the most competent hands its mortality is not greater, but is even less, than the mortality of gastro-enterostomy; that a prolongation of life for ten months longer than the period given by gastro-enterostomy is the rule; that the comfort...
Page 103 - That bacteria and their toxins are the chief causes of extensive postoperative thrombosis, as well as thrombosis occurring in the course of infectious diseases, is now fairly well established. By no means all postoperative thrombi occur in the field of operation. Phlebitis and a resulting thrombus are all too frequent. The last dec-ad has seen a very marked extension of our knowledge of the frequent infection of the blood-stream by bacteria.

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