210 CANINE AND FELINE SURGERY 



sides of the bowel in such a wa}- that (\\hen returned), if 

 straining takes place, these approach one another and 

 mechanicall}' prevent aversion. After as much has been 

 inserted as is deemed sufficient to effect the required purpose, 

 the still prolapsed and everted gut is carefully manipulated 

 between the fingers and gradually returned, the middle 

 iinger being inserted to adjust the mucous membrane. 



In doing this operation, care must be taken to puncture the 

 mucous membrane in as few places as possible, the wax 

 having an unpleasant habit of escaping freely through the 

 tiniest hole. The operator, too, must ah\a}'s be prepared 

 to guide the fluid wax in the proper direction, and to mould 

 it into the required shape. ^ 



The author has had the opportunity of testing Gersuny's method on 

 five most troublesome cases of prolapse, all the patients being bull-dogs. 

 In one case the bowel had been prolapsed no less than fourteen times, 

 in a second eight or nine times, and in a third the owner had periodically 

 had to have it returned during a period of three months. In each instance 

 pessaries and sutures of various patterns (interrupted and tobacco-pouch) 

 had temporarily kept the bowel up, but eventually it always protruded 

 again. In every case a successful and permanent result was attained. 



Proctopexia, or Ventrifixation of the Bowel, — When a 

 prolapse takes place again and again, and no adhesions have 

 formed, laparotomy is performed in the median line (see 

 p. 158), and the bowel drawn inwards and fixed to the 

 abdominal wall. Several catgut or kangaroo tendon sutures 

 are used, being passed through the mesentery and abdominal 

 muscles whilst the bo\\'el is held away from the direction of 

 the pelvis. Catgut and kangaroo tendon are better than fine 

 silk as suture material, because they take longer to become 

 absorbed, and so allow more time for firm adhesion to take 

 place ; silkworm gut would soon tear its way out. 



After the sutures have been inserted, the abdominal wound 



1 Veterinary Record, 1904. (Proceedings of the Liverpool University 

 Veterinary Medical Society.) 



