SURGERY OF THE INTESTINES: WITH SPECIAL REFERENCE TO THE UNDERLYING BIOLOGIC PRINCIPLES

The biologic processes that take place during the healing of any wound are always interesting, but a knowledge of what goes on during the healing of a properly sutured intestinal incision is necessary in order to comprehend the reasons for the technic.The law of apposing peritoneal surfaces in suturing wounds of the bowel was the first great step in the progress of intestinal surgery, and was established by Antoine Lembert in 1826, nearly a hundred years ago. This principle followed observation of nature's method of closing perforations by peritoneal adhesions and a deposit of lymph.Hertzler 1 has demonstrated that the healing of the peritoneum of wounds is due to the direct transformation of the deposit of lymph into connective tissue without the intermediate stage of granulation tissue formation. This direct transformation, however, can occur only when there is no marked infection. Otherwise, healing is by granulation.Within a