166 DISEASES OF THE STOMACH 



cartilage to the umbilical scar. Grasp the stomach and draw 

 it up through the opening. Ligate the right and left branches 

 of the gastric arteries, the splenic and the gastrohepatic 

 arteries. The location of the ligatures along the arteries 

 depends on the location of the excision. In all cases the 

 ligatures must be close to the excision to avoid having an 

 area of the stomach left without blood supply. Place a gas- 

 trectomy forceps, the jaws protected with rubber tubing, 

 across the stomach just back of the point of each excision, 

 and two others across the part to be removed far enough 

 from the others to allow cutting between them with shears. 

 The forceps protect against hemorrhage and escape of con- 

 tents while the latter prevent escape of material contained 

 in the part to be removed. Remove by cutting between the 

 clamp with scissors and suture both ends with continuous 

 suture over and over the cut edges to control hemorrhage, 

 and invert the ends by putting in Lembert sutures. Remove 

 the forceps and take up a part of the anterior wall of the 

 stomach and apply the forceps, having the part that projects 

 through the forceps about two inches long by one-half inch 

 through. Do the same with the duodenum about three 

 inches from the pylorus. Place the forceps close together 

 and apply sutures through the muscular coat close to the 

 lower jaw of each forceps, and do not cut off the suture. 

 Then make an incision in the stomach close to the line of 

 sutures and one in the duodenum to correspond with the one 

 in the stomach. Then with a new suture join the distal 

 edges of the wound with Council's sutures, the forceps being 

 loosened but left in place to support the stomach. These 

 latter sutures invert the cut edges and the first suture can 

 now be continued over the Connell suture as a Lembert 

 suture. Return the organs and suture the laparotomy 

 wound. After forty-eight hours feed liquid food for several 

 days. 



