Adequate exposure is mandatory for a safe anastomosis between the esophagus and jejunum. Some operators prefer to split the lower sternum in the midline and extend the incision to the left into the fourth intercostal space. Matte Soft Cover with 120 Blank Lined Pages Recueil Des Travaux Scientifiques de L on Foucault, Volume 1. Active bleeding points in the xiphocostal angle are transfixed with 00 silk sutures, and bone wax may be applied to the end of the sternum. Download PDF, EPUB, MOBI Oxford Readings in Propertius Read online free Labrador Mom Book Lover : Fun Dog Mom Notebook Journal. Additional exposure is allowed by removal of the xiphoid. Because of the high incidence of metastases, a more liberal incision extending up to the region of the xiphoid and down to the umbilicus, or beyond it on the left side, is not made until it has been determined that there is no contraindication to total or subtotal gastrectomy ( FIGURE 1). The initial opening is only to permit inspection of the stomach and liver and to introduce the hand for general exploration of the abdomen. If this view is clear, then a limited incision is made in the midline ( FIGURE 1, A–A1) between the xiphoid and umbilicus. A diagnostic laparoscopy is often performed first to rule out inoperable spread of a malignancy (see Chapter 15).
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