Ba

Figure 25-17 Enter orrhaphy by the Czerny-Lembert interrupted suture. A, Interrupted Lembert suture through serous, muscular, and part of submucous coats—applied from without. B, Interrupted Czerny suture through mucous and part of submucous coats—applied from within. The latter is applied first.

Figure 25-18 The Gould inverted mattress suture overlying the through-and-through marginal suture.

Figure 25-18 The Gould inverted mattress suture overlying the through-and-through marginal suture.

Figure 25-19 The sutures in the first half of the anastomosis are placed from within the lumen, as shown. Slight tension on Guy sutures (B and C) facilitates inversion of the edges. The proximal and distal occlusive ligatures are placed before dividing the bowel. (From Gambee, L.P., Garnjobst, W., and Hardwick, C.E.: Ten years' experience with a single layer anastomosis in colon surgery. Am. J. Surg., 92:222, 1956, with permission.)

Figure 25-21 Heineke-Mikulicz pyloroplasty with one-row suture technique. A, Longitudinal incision across pyloric ring extending through all layers, including mucosa. B, Pyloroplasty retractors convert wound by lateral traction and at the same time provide exposure for accurate placement of sutures. C, Inset shows Gambee stitch, which aligns mucosa to mucosa. D, Completion of pyloroplasty. (From Weinberg, J.A.. Vagotomy and pyloroplasty for duodenal ulcer. Am. J. Surg., 92:203, 1956, with permission.)

Figure 25-21 Heineke-Mikulicz pyloroplasty with one-row suture technique. A, Longitudinal incision across pyloric ring extending through all layers, including mucosa. B, Pyloroplasty retractors convert wound by lateral traction and at the same time provide exposure for accurate placement of sutures. C, Inset shows Gambee stitch, which aligns mucosa to mucosa. D, Completion of pyloroplasty. (From Weinberg, J.A.. Vagotomy and pyloroplasty for duodenal ulcer. Am. J. Surg., 92:203, 1956, with permission.)

References

1. Belsey, R.: Reconstruction of the esophagus with left colon. J. Thorac. Cardiovasc. Surg., 19:33, 1965.

2. Bronwell, A.W., Rutledge, R., and Dalton, M.L., Jr.: Single-layer open gastrointestinal anastomosis. Trans. South. Surg. Assoc., 78:281, 1966.

3. Canalis, F., and Ravitch, M.M.: Study of healing of inverting and everting intestinal anastomoses. Surg. Gynecol. Obstet, 126:109, 1968.

4. Collis, J.L.: Surgical treatment of carcinoma of the oesophagus and cardia. Br. J. Surg., 58:801, 1971.

5. Deveney, K.S., and Way, L.W.: Effect of different absorbable sutures on healing of gastrointestinal anastomoses. Am. J. Surg., 133:86, 1977.

6. Gambee, L.P.: A single layer open intestinal anastomosis applicable to the small as well as the large intestine. West. J. Surg., 59:1, 1951.

7. Gambee, L.P., Garnjobst, W., and Hardwick, C.E.: Ten years' experience with a single layer anastomosis in colon surgery. Am. J. Surg., 92:222, 1956.

8. Getzen, L.C.: Clinical use of everted intestinal anastomosis. Surg. Gynecol. Obstet. 123:1027, 1966.

9. Getzen, L.C.: Intestinal suturing. I. The development of intestinal sutures. II. Inverting and everting intestinal sutures. Curr. Probl. Surg., August, September, 1969.

10. Getzen, L.C., Roe, R.D., and Holloway, C.K.: Intestinal Anastomosis: Inverted and Everted; A Gross and Microscopic Comparative Study. Exhibit, American College of Surgeons Congress, Chicago, 1964.

11. Getzen, L.C., Roe, R.D., and Holloway, C.L.: Comparative study of intestinal anastomotic healing in inverted and everted closures. Surg. Gynecol. Obstet., 123:1219, 1966.

12. Goligher, J.C.: Visceral and parietal sutures in abdominal surgery. Guest Oration. 16th Annual Meeting, Society for Surgery of the Alimentary Tract, San Antonio, Texas, 1975. Am. J. Surg., 131:130, 1976.

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