Operative surgery . Fig. 812.—Cup seized for 813.—Spring cup seized for introduction,flange should be pushed down before grasping. Spring Fio. 811.—Section of smallintestine and Serous coat. h. Mus-cular coat, c. Submucousfibrous coat. d. Arteryto bowel. e. Reverseoverstitch and puckeringstring. f. Triangularspace, g. ^Mesentery. tery, which is grasped by a reverse overstitch (e),followed by a continuation of the topstitch upthe opposite side to the point of beginning. Itis noted that the ends of the suture are left longthat they may be readily grasped. One cup
Operative surgery . Fig. 812.—Cup seized for 813.—Spring cup seized for introduction,flange should be pushed down before grasping. Spring Fio. 811.—Section of smallintestine and Serous coat. h. Mus-cular coat, c. Submucousfibrous coat. d. Arteryto bowel. e. Reverseoverstitch and puckeringstring. f. Triangularspace, g. ^Mesentery. tery, which is grasped by a reverse overstitch (e),followed by a continuation of the topstitch upthe opposite side to the point of beginning. Itis noted that the ends of the suture are left longthat they may be readily grasped. One cup of thebutton is then seized at the stem with forceps(Fig. 812), and is carried into the open end of theintestine and held there, while the puckering stringis drawn tightly and tied at the base of the stem. 630 OPERATIVE Fig. 814.—Parts prepared for joiniii The remaining cup and end of the bowel are treated in a siniihir manner(Fig. 813), after which the cups are joined and pushed firmly together(Fig. 814). Extremities of unequal diameter can be united in a similarmanner to that employed for those of a like caliber. For the purpose of making a longer and perhaps more permanent open-ing between approximatedviscera, Murphy devisedan oblong button whichdoes not differ in its mech-anism and application fromthe round button in anyessential respect (Fig. 815).This variety is commendedby Murphy for use in lateral approximation of intestines with each otherand in the performance of gastro-enterostomy. Lateral Approxitnation.—Either the round or oblong button can beemployed in lateral approximation. The use of the latter is followed bymuch the larger anastomotic opening, and for this reason, at least, may the better agent for the purpose. The puckering string in lat-eral approximation is placed
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