Annals of Surgery (Volume 25) (Paperback)

Purchase of this book includes free trial access to www.million-books.com where you can read more than a million books for free. This is an OCR edition with typos. Excerpt from book: TRANSACTIONS OF THE NEW YORK SURGICAL SOCIETY. Stated Meeting, October 14, 1896. Andrew J. McCosn, M.D., in the Chair. GASTROSTOMY BY KADER'S METHOD. Dr. Willy Meyer presented a man upon whom he had performed gastrostomy for malignant obstruction of the pylorus by Fig. i. Kader's method. He first pointed out briefly the respective advantages and the modes of operating of the former three useful methods of gastrostomy, ?viz., Von Hacker's, Witzel's, and SsabanejewFrank's. Lately he had specially made use of the Von Hacker and of the Frank method, since 1894 in nine cases, but had not employed Witzel's on account of the trouble which is sometimes encountered on bluntly dividing the abdominal muscles in the line of Fenger's incision. He then mentioned the advantages of Kader's method, which he had first employed in a case last July, shortly after the first description of it was first published, and explained, with the help of diagrams, the different steps of the operation. The four figures (see Figs. 1?4) show these different steps, including the manner of introducing the sutures. The course of the operation is as follows (see New York Medical Journal, November 7, 1896): After blunt division Fig. 2. of the left rectus muscle?no doubt the most preferable road?the abdomen is entered, the stomach pulled forward and primarily opened by a very small incision. A drainage-tube of the size of a lead-pencil is at once introduced and fastened to the gastric wall by a catgut stitch (Fig. i, a). Then a fold of the stomach wall (sero-muscular layers) is raised on either side of the tube about half an inch wide, and the two are drawn together by sutures, two above and two below the tube (deep occlusion-sutures). (See Fig. i.) (These folds can also be placed in a transverse d...