The Abdomen 141 



ligated omentum tend to give rise to trouble through mortification 

 of the occluded end. But, unless the conditions actually demand 

 its removal, it is bad surgery to excise this organ. For the omen- 

 tum performs an important function in the healing of abdominal and 

 visceral wounds. It plays the part of an operculum, invariably be- 

 coming adherent to the internal face of the wound or to wounded 

 surfaces of organs. In certain cases of hernia where its reduction 

 would present considerable difficulty it may be removed with ad- 

 vantage. 



Because of this protective capacity of the omentum, which is 

 in reality a fold of peritoneum, it is quite unnecessary to stitch the 

 parietal peritoneum. 



In certain cases provision must be made for drainage. I have 

 reference to conditions threatening to give rise to peritonitis. 

 Wherever perforation of the bowel or infected uterus is on the verge 

 of taking place, or has taken place, or microbic invasion has al- 

 ready occurred, the necessity for drainage becomes imperative. 

 The method is simple, and requires only the insertion of a strip of 

 sterile gauze in the course of the wound, one extremity being placed 

 within the peritoneal cavity, the other being allowed to protrude 

 through the skin. This should be left in place some five or six 

 days. 



In bringing the edges of the muscular wound into contiguity 

 some operators apply independent sets of sutures to each of the 

 divided coats. Others use but one set of sutures to include all the 

 coats. In the median position there is but one small muscular coat 

 to unite, though the aponeuroses of the others should be included. 

 Much of the strength of the abdominal wall lies in the fascia in 

 front of the recti muscles. When interrupted sutures are used no 

 stitch should be tied until all are inserted, the curved needle being 

 employed, and then tying is to be commenced at each commissure 

 and gradually completed toward the center. When the opening 

 has been made directly through the linea alba, La Torre advises 

 that the aponeurotic tissue be removed as far as the muscular sub- 

 stance of the recti muscles, owing to the yielding tendency dis- 

 played by cicatrices of the former class of tissue. 



When the epigastric artery and veins have been tied, the liga- 

 tures are very apt to become displaced or slip while the sutures are 

 being applied to the wall. This accident may escape the operator's 



