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• W1991650839 abstract "<h2>Abstract</h2> Ureterotomy for the removal of renal calculi has certain advantages, but should the ureteral incision fail to heal, one is driven to the necessity of removing the kidney. In cases of renal calculi ureteropyelolithotomy has been resorted to by me from 1901 to 1916. In the latter year there came under my care a patient with stone of considerable size in the renal pelvis. This was removed through an opening made in the upper ureter, but the delivery of the stone caused an irregular extension of the incision, difficult to repair, which became infected, with resultant persistent fistula. Nephrectomy was finally necessary. This unfortunate outcome directed my attention to the development of a nephrotomy technique for the removal of renal calculi with less liability to urinary fistula, and provision for the control of renal hemorrhage. The feature of the technique pertained chiefly to the closure of the renal incision and the removable sutures encircling the kidney, which are utilized, should necessity demand it, to stop postoperative hemorrhage. When the kidney is delivered and freed from its cellular tissue, the renal vessels are isolated and are compressed directly by a ring forceps covered with rubber. A median longitudinal incision is now made through the kidney and the calculi are removed. The kidney incision is closed by passing a cambric needle large enough to accommodate No. o chromicized catgut. The suture is doubled, but its free ends are not tied. The small canal made by the needle is completely filled by the double suture. The needle is passed through the kidney substance on a plane with the cut edges of the pelvic incision and repassed on the same plane in the opposite direction so as to form a loop. The securing of this suture may be made in one or both of the following ways: (i) the needle end of the double suture, after its final emergence, is passed through the double loop on the opposite surface and tied over the convex border to the free ends; (2) the double suture is severed from the needle and one of the severed sutures is tied as a mattress suture while its companion single suture is dealt with in a similar manner, as are the double sutures in the hrst method. Two b. and b. tension sutures are now passed completely around the kidney, one just above the upper and the other just below the lower limits of the hilum. To prevent these sutures from losing their positions they are made to penetrate superficially the anterior and posterior surfaces of the kidney, deep enough only to secure an anchorage in the fibrous capsule. After releasing the hemostatic clamp and returning the kidney to its bed, the free ends of the silk sutures are passed through all of the tissues on one side and the other of the lumbar incision and tied in a bow-knot over a bolster of iodoformized gauze. These sutures, when tightened as necessity indicates, will insure hemostasis and anchorage of the kidney to the abdominal wall." @default.
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• W1991650839 date "1927-05-01" @default.
• W1991650839 modified "2023-09-25" @default.
• W1991650839 title "The control of hemorrhage following nephrotomy for the removal of calculi" @default.
• W1991650839 doi "https://doi.org/10.1016/s0002-9610(27)90519-4" @default.
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