The Abdomen 



189 



Halr-pla method of anafitomosls. 

 Second stage. 



ceeding to the other side. The bowel is turned over and the 



sutures are applied in the same manner on the other side. The 



pins are then severed at 



their bent ends with bone 



forceps or stout scissors, 



untied and undamped, 



and withdrawn, one prong 



at a time. The remaining 



openings are closed with 



one stitch each, particular 



care being exercised that 



the margin is properly 



turned in at the mesen- 

 teric attachment. Finally, 



the incision in the mesen- 

 tery is closed with contin- 

 uous suture. 



The bent pin method 

 is equally serviceable for lateral anastomosis, a portion of the 

 greater curvature being included between the two prongs in a direc- 

 tion approximately parallel with the long axis of the gut. 



Of the mechanical devices employed in this operation it is only 

 necessary to refer to the metallic button of Murphy. Other absorbable 

 substitutes have been suggested and employed, but they are all made 

 on the same principle. They are somewhat difficult to use on ac- 

 count of the contraction and eversion which takes place immediately 

 the bowel is divided, and they involve a postoperative risk, because 

 they remain in place for a longer or shorter period, thereby becoming 

 foreign bodies, and because they effect reunion by pressure-necrosis. 

 The Murphy button is made in various sizes, only the smallest of 

 which is applicable to canine surgery. It consists of two interlock- 

 ing halves, either of which is inserted in each open end of the bowel. 

 The margin of the latter is then gathered around the stem of the 

 button by means of a purse-string suture, the t^o halves of the 

 button are locked by pressing them together, thus bringing serosa 

 into apposition with serosa, and the union is completed. A few 

 Lembert sutures may be applied additionally if it is desired to 

 reinforce the line of union. The button sloughs when a certain 

 degree of reunion has taken place and is voided at the anus in the 

 course of ten or fifteen days. 



