INDEX OF SURGICAL PROGRESS

1890 Annals of Surgery  
1887, Hahn first performed gas¬ trostomy through the eighth intercostal space. Since that time he has performed 8 operations by this method in all, and comparing this with 7 cases operated upon previously by Fenger's method, expresses him¬ self as being decidedly in favor of the former. His method is as fol¬ lows: An incision is made parallel with the lower edge of the last lower rib, and the abdominal cavity opened. A second incision is made in the 8th intercostal space, close to the juncture
more » ... se to the juncture of the 8th and 9th in¬ tercostal cartilages, through skin and muscular tissues, in a direction obliquely from above downward and outward. I he parietal perito¬ neum at this point is punctured by a pair of curved dressing forceps, or incised; this is enlarged by spreading the forceps. The thumb and index finger of the left hand are introduced into the first-made abdom¬ inal wound, and the stomach sought for at a point corresponding as neaily as possible to the fundus. This is grasped by the dressing for¬ ceps and drawn through the 8th intercostal space, until the stomach wall overlies the surrounding integument for the space of 1 ctm. Af¬ ter covering the wound made first with antiseptic gauze, the stomach, in case the opening is to be made at a subsequent sitting, is sutured by means of its serous covering only to the edges of the wound. In case it is to be opened at once, the serous, muscular and mucous coats are together attached to the opening in the inter¬ costal space. The abdominal wound is then sutured. After numer¬ ous trials upon the cadaver, Hahn found that there was no danger of wounding the diaphragm if care was taken to always select the space between the cartilages of the 8th and 9th ribs, inasmuch as the former (214)
doi:10.1097/00000658-189012000-00018 fatcat:gym7shbpmvbwlnlj6gapmeitd4