File:Interstate medical journal (1917) (14781319004).jpg

Identifier: interstatemedica2419unse (find matches)
Title: Interstate medical journal
Year: 1917 (1910s)
Authors:
Subjects: Medicine
Publisher: St. Louis, : Interstate Medical Journal
Contributing Library: The College of Physicians of Philadelphia Historical Medical Library
Digitizing Sponsor: The College of Physicians of Philadelphia and the National Endowment for the Humanities

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ts united in themost normal relation with each other is to be preferred. For thisreason the segmental resection with terminal union is to be chosen.The disposition of the sutured ends depends on circumstances.Often it appears prudent to leave them loosely attached to theperitoneum behind the wound; occasionally it seems wise to close 14 INTERSTATE MEDICAL JOURNAL the peritoneum about the anastomosis (as in the authors methodof enteroureteral anastomosis) ; but the important point is to leavethe operated field accessible in the event that necessity arises tosecure relief from gas or from leakage. The above operative procedures are illustrated in the accompany-ing illustrations. Fig. 1 represents the method in common prac-tice. It is open to the criticism that it removes more tissue thanthat directly diseased, including the sphincter. In the after-resultit is absolutely impossible to determine in any particular case whatresults, good or bad, are properly ascribable to the removal of the
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Pig 4.—step in advancement of ileocecal valve, illustrating method of placingclamps, the line of incision distal to the valve, and the preservation of theileocolic vessels intact until after resection is completed. ileum, the valve, or the more pathological ceco-colon. Fig. 2depicts the Lardennois method, little known in this country. Thisoperation conserves more normal tissue than the preceding andat the same time some of the supposedly most diseased colon—thececum. Fig. 3 has been originated by the author to dispose of theobjectionable points of both of the above—namely, to conserve the INTERSTATE MEDICAL JOURNAL 15 good tissue, including the sphincter, and dispose of the bad. Thevalve may be advanced to any level along the colon, and thecollar may be trimmed to fit the cut end of the distal colon. TECHNIC OF ADVANCEMENT OPERATION. An incision of ample working size is made through the rightrectus. The abdomen is gently explored. Special attention is giventhe alimentary tract a

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