Identifier: textbookofoperat1903koch (find matches)
Title: Text-book of operative surgery
Year: 1903 (1900s)
Authors: Kocher, Theodor, 1841-1917 Stiles, Harold J
Subjects: Surgery, Operative Surgery
Publisher: London : Adam and Charles Black
Contributing Library: Yale University, Cushing/Whitney Medical Library
Digitizing Sponsor: Open Knowledge Commons and Yale University, Cushing/Whitney Medical Library

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Fig. 97 illustrates the use of the clamp-forceps iu resection of the pylorus ; they simplify the opera-tion, but if improperly used they may interfere with the nutrition of the edges of the wound.After the tumour is excised the clamp-forceps are applied to the stomach and duodenum toprevent escape of contents and to temporarily control the vessels. The divided vessels at theupper and lower surfaces of the duodenum are wrongly drawn ; they ought to appear as ifdivided in the same plane as the duodenum. The manner in which the suturing is done so as to securely close the stomach andat the same time insure against contamination by the escape of any of its contentsis well shown in Figs. 98 to 101. As will be seen, a continuous mattress suture,after the manner of a half Gelys suture, is carried close behind the crushing-forceps AH DOM UN 219
Text Appearing After Image:
igs. 98 and 99.—Introduction of the occlusion sutureprevious to removal of the crushing-forceps.-The stomach has been cut across close to the forcepsand a continuous mattress suture (straight needle) is beingpassed through both its edges on the proximal side of theforceps, so as to prevent any escape of conteuts on removalof the forceps. 99.—The crushing-forceps have been taken off. and the endsof the suture are held taut (the lower end is not yet knotted).The redundant mucous membrane is cut away with scissors. OPERATIVE SURGERY Fig. 100. £ A i (Fig. 98); only the commencement is knotted, and by pulling on the two ends reliableclosure is effected. If the crushing-forceps are not strong enough to compress thetissues so that they are like thin dry paper, it is desirable that every projectingportion of mucous membrane and muscular pulp should be clipped away with scissors(Fig. 99), but this is unnecessary if sufficiently powerful compression (crushing)forceps are employed. With the

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