By Jameson L. Chassin
After discussing the idea that and operative method, Dr. Chassin provides an in depth description of each operation mostly surgical procedure - the digestive tract, breast, belly wall, and chosen head and neck and endocrine operations -, every one copiously illustrated with distinct, stylish drawings by means of Caspar Henselmann. a necessary reference for all citizens and training surgeons.
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Additional resources for Operative Strategy in General Surgery: An Expositive Atlas Volume 1
When a sutured anastomosis is performed with everting technique, the results are inferior to the inverted seromuscular anastomosis. On the other hand, the everted stapled anastomosis in experimental animals healed nicely with even less inflammation in the first 10-15 days than did the inverted sutured anastomosis. Extensive experience in humans, reported by Steichen and Ravitch, confirms the safety of mucosa-tomucosa approximation when it is performed by stapling devices (see also Complications of Stapling Compared with Suturing, p.
Irrigation of the depths of the wound with an antibiotic solution can be undertaken by disconnecting the catheter from the suction device and instilling the medication with a sterile syringe. The closed-suction drain should not be left in the abdomen for more than 10 days as we know of cases where tissues have been sucked into the fenestrations of a Jackson-Pratt catheter so firmly that it was impossible to remove the catheter except by relaparotomy. Gauze Packing When a gauze pack is inserted into an abscess cavity and is brought to the outside, the gauze in effect serves as a drain.
One should assume that the fine wire in the staples will tend to cut through tissues more readily than sutures, thereby producing a leaking anastomosis. This is a clinical impression unsupported by data, but we have observed a colostomy closure fail because of the postoperative dehiscence of the staple line. This occurred because the surgeon did not free enough proximal and distal colon from adhesions to the parietal peritoneum to relieve tension on the stapled closure. Other complications of this type are discussed in the section on staple complications (see below).