. Operative surgery, for students and practitioners . is to insure the turning in of a seroussurface at this point and at the same time to do away with themesenteric dead space; besides, it gives a fixed point to the introducing the button the first double loop of a surgeonsknot should be taken with the ends of the purse-string. One-half of the button, grasped with a thumb forceps by theedge of its tubal part, is now introduced into the end of the gut,turning the button a little on the side to facilitate its introduction,and while it is thus held the purse-string is tied around i
. Operative surgery, for students and practitioners . is to insure the turning in of a seroussurface at this point and at the same time to do away with themesenteric dead space; besides, it gives a fixed point to the introducing the button the first double loop of a surgeonsknot should be taken with the ends of the purse-string. One-half of the button, grasped with a thumb forceps by theedge of its tubal part, is now introduced into the end of the gut,turning the button a little on the side to facilitate its introduction,and while it is thus held the purse-string is tied around its shank,leaving the flange within the intestine. The ends of the purse-string are cut short so that they will not protrude between the 304 ABDOMEN AND BACK. flanges of the button when this is closed. This procedure is repeatedupon the other segment of gut. The two halves of the button arethen deliberately pressed home, and in doing this one should notethat the corresponding mesenteric attachments of both segments ofthe gut are opposite each Fig. 135.—End-to-End Anastomosis (Murphy Button).With the purse-string suture a loop is taken throughthe layers of the mesentery, close to the wall of thegut, in order to obliterate the dead space. Fig. 136.—Murphy But-ton, the Two HalvesSeparated. When the two halves of the button are locked there should bepresented between them a clean, smooth line with no raw mucousmembrane edge protruding, and at the mesenteric attachment theapposition of serous surfaces should also be assured. Should there beany protruding edge of mucous membrane between the flanges of the OPERATIONS UPON THE SMALL INTESTINE. 305 button after this has been locked, it may be seized with a thumbforceps and trimmed off short with the scissors. Any doubtful pointsshould be made secure by adding several Lembert sutures. Although it is probably not necessary in most cases to use a layerof Lembert sutures in addition to the Murphy button to secure ac-curate apposi
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