DEPARTMENT OF SURGERY. 
435 
END-TO-END ANASTOMOSIS. 
A, Ends of intestine to be approximated when of different calibre ; i?, ends when reduced to the 
same calibre ; a, Czerny stitches ; b, Lembert stitches ; c, line where longitudinal incision is- 
made. 
and suturing it with Czernv-Lembert's suture (Rev. XXIV., 4, 
p. 282), and when of uniform calibre, are approximated and 
sutured by using the method of suturing approximations which 
the surgeon considers most appropriate (Rev., Vol. XXIV., No. 
4, Surg. Dep’t.). It is advisable to get as much of the contents 
of the intestine in region of the part to be resected into the 
portion that is to be resected and ligate both ends of it, pro¬ 
viding that it is not perforated. If perforated either from dis¬ 
ease or trauma, the opening may be enlarged if necessaiy, and 
contents removed through it; and if any of the contents or sep¬ 
tic products from the diseased portion should escape into the 
cavity, it must be removed at once by irrigation ; sterilized 
water or a mild antiseptic solution may be used for this pur¬ 
pose. After the intestinal operation is completed the cavity 
should be irrigated again and the abdomen closed in the usual 
manner. The after-treatment is the same as in lateral anasto¬ 
mosis. 
When a large portion of the intestine is removed the results 
are generally not so satisfactory as those following a small re¬ 
section. The danger of infection is increased ; the system is 
depleted by shock and haemorrhage ; and the function of diges¬ 
tion and absorption is impaired to a certain degree by the loss 
of the portion resected ; together with a number of unavoid- 
