Oncology Patients With
Cylinders for Intracavitary
of Uterine Afterloading Applicators
for Intracavitary Radiation Therapy
Injection of Chromic Phosphate
Omental Pedicle "J"
With Bilateral Inguinal
Lymph Node Dissection
Vulva With Gracilis Myocutaneous Flaps
Flap and Vertical Rectus
Bilateral Pelvic Lymph
Node Dissection and With Extension of the Vagina
"J" Pouch Rectal
Omental "J" Flap
Continent Urostomy (Miami Pouch)
Gracilis Dynamic Anal
System Versus Skin Grafting
Pelvic Flap for
Augmentation of Continent Urostomy or Neovagina
of Hemorrhage in Gynecologic Surgery
of the Punctured
of a Lacerated
Internal Iliac Vein and
Suturing of a Lacerated Common Iliac Artery
Suspension of the Vagina
Not to Do in Case of Pelvic Hemorrhage
Associated With Abdominal Pregnancy
A tube gastrostomy can be used following extensive gastrointestinal
surgery to decompress the intestines and, when indicated, to supply
Physiologic Changes. The gastrostomy
tube decompresses the stomach and, while the adynamic process is
in place, prevents air from passing into the small bowel. Hydrochloric
acid is removed from the stomach. The volume of secretions removed
from the stomach should be replaced intravenously with sodium chloride.
The alternative to tube gastrostomy is a nasogastric tube. This is
a space-occupying mass in the mediastinum. The tube gastrostomy eliminates
the need for a nasogastric tube, thereby reducing dead space and improving
Points of Caution. Care must be taken to see that
the gastrostomy tube is within the lumen of the stomach and has not
been pulled back into the peritoneal cavity. This is accomplished by
suturing the parietal peritoneum to the visceral peritoneum surrounding
the gastrostomy and placing skin sutures to the gastrostomy tube.
This automatic pursestring suture device
(United States Surgical Corp.) speeds the placement of the feeding
The stomach wall is picked up with a Babcock
clamp. The automatic pursestring instrument is applied to a zone
of the stomach.
An incision is made within the circle of
staples placed with the automatic pursestring suture device.
An incision is made on the
anterior abdominal wall at a convenient point adjacent to where
the stomach would come up to the anterior abdominal wall.
A Kelly clamp is inserted through that incision,
and a Malecot catheter is grasped in the Kelly clamp.
An incision is made through
the middle of the pursestring sutures into the stomach wall.
The Malecot catheter is seen piercing the abdominal wall into
the peritoneal cavity.
The tip of the Malecot catheter is pushed
through the defect in the stomach. The pursestring suture is
tied. Additional sutures are placed between the parietal and
visceral peritoneum to seal off the stomach, where the catheter
goes through both structures.
The Malecot catheter is seen piercing the
abdominal wall, piercing the stomach, and resting within the