. La cirugía moderna, generales y operativos. , Y si el crecimiento se encuentra retire-able, la incisión se agranda. En algunos casos será necesario dividethe msculo recto mediante un corte transversal. Método de los Mayos.-Este es el mejor funcionamiento. El método Billroth,que durante mucho tiempo fue empleado, no retire suficiente estómago si hay enfermedad ismalignant, la abertura que queda en el estómago es mucho mayor, y en la apertura theduodenal sutura, así como para hacer las dos aberturas de equalsize un ángulo está a la izquierda, que es apto para la fuga. Se muestra el funcionamiento de billroths inI^IGS. 735 y 736. En la Mayo

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. Modern surgery, general and operative. , and if the growth is found to be remov-able, the incision is enlarged. In some cases it will be found necessary to dividethe rectus muscle by a transverse cut. Method of the Mayos.—This is the best operation. The Billroth method, which was long employed, does not remove enough of the stomach if there ismalignant disease, the opening left in the stomach is much larger than theduodenal opening, and in suturing so as to make the two openings of equalsize an angle is left which is apt to leak. Billroths operation is shown inI^igs. 735 and 736. In the Mayo method, after the stomach has been exposedthe gastric artery is ligated close to the stomach, the lesser omentum is tiedin several segments close to the liver and then divided, and the pyloric arteryis tied. Two clamps are applied to the duodenum i inch apart, and the duo-denum is divided by means of the cautery (Fig. 737). The right end of the duodenum is closed by means of a continuous catgut Method of the Mayos for Pylorectomy 1223. Fig. 737.—Pylorectomy by the Mayomethod: Clamps applied, duodenum divided, and continuous catgut stitch introduced(Mayo). suture, the clamp is removed, and the closed end of the duodenum is inverted by a purse-string suture (Fig. 738). A hand is i)assed from above Ijaclc of the stomach and lifts the great omentum forward. The right gastro-epiploic artery is tied close to the stomach. The left gastro-epiploic artery is tied distinctly to the left of any enlarged glands in the great omentum. The great omentum is tied in several segments. The great omentum is divided, leaving any enlarged glands attached to the portion of the stomach it is the intention to remove. The stomach is to be divided to the left of all lymphatic glands into which the cancerous region drains. The clamps are applied as shown in Fig. 737. The stomach is divided be-tween the clamps by a cautery, and as the division is being carried out the stump is caught here and there by h

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• bookcentury1900
• bookdecade1910
• bookidmodernsurger
• bookyear1919