. Manual of operative surgery. eans ofthe cautery knife. Do not try to destroy the growth with the cautery, butlift it up with forceps and dissect it away, using the cautery as a knife. 4. Close the wound in the bladder by through-and-through catgut stitchesintroduced in the Connel fashion (Fig. 847). Put in a second layer of stitches(hemp) in the continuous Lembert or Gushing fashion. At the lower end ofthe cut, where the bladder is not covered with peritoneum, it is easy to so loosenthe parietal peritoneum continuous with the vesical peritoneum that it can bemade to lie on the bladder and pe
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. Manual of operative surgery. eans ofthe cautery knife. Do not try to destroy the growth with the cautery, butlift it up with forceps and dissect it away, using the cautery as a knife. 4. Close the wound in the bladder by through-and-through catgut stitchesintroduced in the Connel fashion (Fig. 847). Put in a second layer of stitches(hemp) in the continuous Lembert or Gushing fashion. At the lower end ofthe cut, where the bladder is not covered with peritoneum, it is easy to so loosenthe parietal peritoneum continuous with the vesical peritoneum that it can bemade to lie on the bladder and permit the continuation of the Lembert suture 692 OPERATIONS ON THE BLADDER until the bladder is completely closed. Usually no drainage is required, butshould cystitis, etc., demand drainage, provide for it in the following manner:(a) Bring about i to i^i inches of the lowest part of the parietal peritoneumon the left side of the abdominal wound over to the right side of the vesicalwound and fix it there by a few catgut sutures.. Fig. 847.—Partial cystectomy. Suture of bladder. (Mayo.) (b) Make a stab wound in the bladder about % inch to the right of thelower end of the vesical wound. Introduce a split rubber tube containinga strand of gauze into the bladder and bring it out through the lower end ofthe abdominal wound. With fine catgut, suture the parietal to the vesicalperitoneum just external to the stab wound in the bladder and continue this CYSTECTOMY 693 Stitching so as to unite the parietal to the vesical peritoneum just above the lineof the drainage tube. The object of this elaborate method of drainage is to avoid (o) contamina-tion of the belly cavity with urine escaping along the drain; (b) contaminationof the line of Lembert sutures.