File:Annals of surgery (1885) (14783472265).jpg

Identifier: annalsofsurgery44philuoft (find matches)
Title: Annals of surgery
Year: 1885 (1880s)
Authors:
Subjects: Surgery
Publisher: Philadelphia Lippincott
Contributing Library: Gerstein - University of Toronto
Digitizing Sponsor: University of Toronto

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m to be statements offacts so vitally patent as to demand no further discussion, yetthat imperatively indicate restitutional rather than destructivesurgical measures. Of these various restitutional measures,we are, in this discussion, concerned with but the last,—ureteralanastomosis. IV. Methods.—Consideration of the methods scheduledin Section I. will show that the general plan of procedure doesnot vary in any vitally essential detail. In Groups I. and II. apposition of extremities is direct,transverse or oblique, with or without support. Group III. Apposition of extremities is by direct invagi-nation, with or without splitting of segment, with or withoutsupport. Group IV. Apposition of the extremities by lateral inva-gination, without support. In Groups I. and II. Outer, middle and inner coats comeinto direct contact with their several fellows of the other seg-ment. In Groups III. and IV. The middle coats do not apposeeach other, but contact is permitted between the outer sheath
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TRANS-URETERO-URETERAL-ANASTOMOSIS. 697 of the male segment and the inner coat of the female, save whenthe outer sheath of the male segment has perchance been lib-erally scarified,—it then may be assumed that the muscularis ofthe male segment would be brought in apposition with theintima of the female. A modified Joberts invagination sutureseems to have been most commonly employed. V. Personal Work.—It may be readily conceived that alateral spinal deflection would so seriously alter ordinary ana-tomic relations that any one of these excellent methods wouldprove technically difficult, if not actually impossible.* Andagain so large a section of the ureter may be lost, whether asa result of pathologic involvement or surgical intervention, thathere also a similar difficulty, or impossibility, would be con-fronted. With these matters under consideration, and insearch of a method that might prove efficacious, in 1900 wasdevised and performed on two dogs the lateral invagmation ofthe pro

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