A case of gastro-enterostomy for cancer of the pylorus and stomach : good recovery : a new method of suture : with a note as to the patient's condition four months subsequently / by Arthur E. Barker.

  • Barker, Arthur E. J. (Arthur Edward James), 1850-1916.
Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: A case of gastro-enterostomy for cancer of the pylorus and stomach : good recovery : a new method of suture : with a note as to the patient's condition four months subsequently / by Arthur E. Barker. 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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    to be operated on, and fixed each piece of tubing with a catch-forceps. The empty loop of gut was now laid upon the portion of the stomach to be opened ; and a longitu- dinal fold of the latter, about an inch and a half from the great curvature, was pinched up between the finger and thumb of the left hand, together with the collapsed gut. I now made an incision about an inch and a half long in the fold of the stomach, and another corresponding in the approximated fold of gut. These incisions only pene- trated through the serous and muscular tunics, and left the mucous coat of both viscera intact for the present. Still holding the parts, as before, between finger and thumb, I now united the corresponding posterior edges of the wounds by a continuous suture, the needle entering and emerging in each case between mucous and muscular coats, and the threads crossing the cut edges of the muscular and serous coats. In this way, the serous surfaces were closely united from end to end before either viscus was opened. This row of stitches (which were about an eighth of an inch apart) was carried about a quarter of an inch beyond each end of the incision in the coats of the bowel. The moment had now come to open both the stomach and intestine completely; and this was done with a stroke of a scissors through the mucous coat in each case, special sponges being ready to receive any fluid which might escape. A few drachms of succus entericus flowed from the bowel, little or nothing from the stomach opening. After careful cleansing the anterior borders of both openings were now united by a row of interrupted fine silk sutures, introduced according to Czerny's method. When this was completed, the two openings were securely closed ; but, as an extra precaution, the intestine was turned over, and the posterior suture was reinforced by a second row of interrupted sutures, placed about a quarter of an inch away from the first. The anterior row was then similarly reinforced by a row of con- tinuous suture, taking up, as before, only the serous and muscular tunics. The elastic compressors were now re- moved from the gut. Lest there should be any kinking '» of the latter, as in one of Billroth's cases, I stitched its