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The experience of many surgeons teaches that it is often more difficult to close the abdomen of an obese or muscular patient than it is to perform the preceding steps of the operation. If the patient takes a poor anesthesia and is inclined to strain or breathe irregularly, the difficulties of closure will be increased.
Many ingenious instruments have been devised to help retain the viscera beneath the level of the edges of the peritoneum during the course of parietal closure. If such instruments are to be wide enough to offer any material aid, they are usually awkward to remove when the peritoneum is closed very far. If lap pads are used to retain the omentum and intestine, their extraction is often accomplished with considerable tugging, and the intestine or omental tags are pulled through the opening.
The instrument that I have devised and used for some time has the
McNealy RW. VISCERA RETAINER. JAMA. 1935;105(22):1759–1760. doi:10.1001/jama.1935.92760480002007b
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