The process of repair after the resection of the intestine and intestinal suture / by J. Collins Warren.

  • Warren, John Collins, 1842-1927.
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: The process of repair after the resection of the intestine and intestinal suture / by J. Collins Warren. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    directly through it. The bowel to be resected having been drawn out through the wound, was held by the hands of an assistant, and protected with hot cloths and sponges. The seg- ment selected for removal was about two to three inches in length usually, and included the area supplied by one mesen- teric branch. A ligature was placed around this vessel at its origin, and the intestine and a V-shaped portion of omentum were severed by the scissors. The anastomosing branches were then secured by ligature. These branches can be also con- veniently tied before resecting the bowel. The material used for the suture was the finest sewing silk, armed with a needle fitting closely upon it.1 The needle is better short, as an unduly long needle is apt to bend or break. As it is not the purpose of these investigations to test the value of any particular form of suture, it will not be necessary to refer to the different varieties that have been invented from time to time.2 The “interrupted Lembert ” was used in nearly all the experiments. On two occasions a suture devised by Dr. H. W. Cushing, of Boston, which he describes as the “ right-angled continuous suture,” was employed. It was not attempted in all cases to penetrate the submucous fibrous layer, as recommended by Halstead, and in but one instance was there a failure to hold the wound, by which is meant that one only of all the stitches taken failed to hold. There did not appear to be any difficulty in avoiding perforation of the mucous membrane; no signs of such an occurrence were observed in any of the specimens. The first stitch was taken through that portion of the bowel which had no peritoneal covering, namely, that portion lying between the reflected layers of the mesentery. The sutures were continued around the bowel at intervals of about three mm. The mesentery was then sewed with the ordinary interrupted suture. Suture of the intestine, as has probably been observed by every experimenter, is much more difficult in dogs than in the 1 “ Parabola gold-burnished Sharp’s, No. io.” 1 Boston Med. and Surg. Journal, January 6, 1887. Dr. Otis K. Newell.