1909 Journal of the American Medical Association  
Fig. 10 .-The gastro-splenlc and gastrohepatic omenta have been tied and the cardia has been drawn up into the chest. Two clamps are placed across it at C, preparatory to cutting it through with the cautery knife. Fig. 11 .-Stump of the esophagus, E, and the stomach, S, pre¬ viously closed by a Lembert suture, and containing the female half of the button. Above the stump of the esophagus, and in its lumen, lies the male half of the button. These two portions are ready to press together to' form
more » ... s together to' form the anastomosis. Fig. 12.-Anastomosis at A, made by pressing the two halves of the button together. A continuous silk suture is being passed around the point of anastomosis. Even with our latest teehnic the results are far from satisfactory. We have, however, successfully accom¬ plished four resections of the cardia and esophagus, and six lateral anastomoses of the stomach and esophagus without resection. Nevertheless, our work indicates that with a further improvement of teehnic the operation of the anastomosis with a resection can be accomplished without so great a mortality, and will eventually prove a procedure of promise. On the other hand, the operation of anastomosis of the esophagus with the stomach with¬ out a resection, under our present teehnic, is not accom¬ panied with a high mortality. Next to suturing stab and shot wounds of the lungs and extracting from the bronchi foreign bodies that have been located by the z-rays but cannot be removed by means of the bronchoscope, excision of a portion of the lung and amputation of one or more of its lobes (pneumectomy), have been rendered possible by the use of differential air pressure. Eesection of a lobe seems indicated when the greater part of it has become diseased, but its main bronchus cannot be properly reached and isolated. In the human being this condition is frequently encountered. Extirpation of one or more pulmonary lobes, other more conservative methods having failed, will perhaps become the operation of choice in cases of serious de¬ struction of the lung tissue by chronic inflammatory processes, and, of course, in the presence of new growths. The success of the operation for total extirpation of the lung depends on the operators' ability to close thé divided bronchus air-tight. Various methods have been employed for this purpose, as follows : 1. One mass silk ligature around the bronchus and its vessels; amputation; cauterization of the mucosa of the stumps with pure phenol or the Paquelin cautery. 2. Elastic mass ligature around hilus; removal of lobe at second sitting (Lenhartz). ?>. Ligature and division of main bronchus; remnant of lung tissue stitched over stump (Garré). 4. Isolation and temporary clamping of bronchus : curetting of the mucous membrane of the divided bronchus; tight silk ligature; second loose catgut liga¬ ture more centrally around bronchus (Friedrieh). A fifth method of extirpating the lung is developed below. It is original with myself as regards the treat¬ ment of the stump and was perfected in the course of operations
doi:10.1001/jama.1909.92550240001001g fatcat:p2h5s2mzizbwvoa3xnvffeccdy