File:Manual of operative surgery (1921) (14804458093).jpg

Identifier: manualofoperativ1921binn (find matches)
Title: Manual of operative surgery
Year: 1921 (1920s)
Authors: Binnie, John Fairbairn, 1863-1936
Subjects: Surgery, Operative
Publisher: Philadelphia : Blakiston
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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eningby a short (i inch) transverse incision on each side of the drainage track. Theseincisions as a rule, only penetrate to the recti-muscles. Step 2.—Introduce the finger and enucleate the prostate in the usual manner. Step 3.—Pass a metal catheter per urethram into the bladder. Place theopen end of the urethral tube of Pilchers bag hemostat (Fig. 844) over the end CYSTECTOMY 689 of the catheter and fix it by a stitch jKissing throujj;h the eye of the catheter.Withdraw the silver catheter and thus pull the rubber tube through the urethraand the bag hemostat into the neck of the bladder. Distend the bag with air.Bring the inflating tube out through the sui)rapubic opening. This procedurecontrols hemorrhage and secures drainage through the urethra. Pass a rubber tube about i inch in diameter through the suprapubicwound, to project into the bladder for about 3-^ inch. Fix this tube to the skinby sutures. Connect the drain by tubing to an appropriate bottle to collectthe secretions.
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844.—Pitchers bag hemostat(Surg., Gyn. and Ohst.) Pilchers modified Pezzer catheter.(Surg., Gyn. and Obst.) After from 24 to 48 hours remove the bag hemostat and drainage tube.Replace them by Pilchers modification of Pezzers catheter (Fig. 845), whichafter a few hours should drain off all the urine without leakage. After aboutone week the drain may be temporarily closed and urine may be passed perurethram. Generally the drain may be removed on the eleventh day. Cystectomy.—Cystectomy may be partial or complete. Partial Cystectomy.—This operation is mostly commonly indicated in casesof circumscribed malignant neoplasm, and whenever feasible should be carriedout extraperitoneally. The anterior wall, most of the fundus, and some-times even part of the posterior wall of the bladder may be exposed withoutopening the peritoneal cavity. Expose the bladder as in suprapubic cystotomy.Carefully pull the prevesical fold of peritoneum upwards, and by blunt dis-section separate its vesical l

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