. Manual of operative surgery. e diseased segment) belowthe disease and divide the gut. Remove the diseased segment. Step 5.^—^Approximate the divided ends of the intestine. This is usuallypossible if mobilization has been sufficiently free. Moynihan urges that thor-ough mobilization of the splenic flexure, without injury to its vascular supply,is often necessary to secure approximation of the intestine after resection. Method A.—Restore the continuity of the gut by means of Murphys buttonor by the ordinary circular enterorrhaphy. Method B.—C. L. Gibsons method (Annals Surg., July, 1910). Seiz
. Manual of operative surgery. e diseased segment) belowthe disease and divide the gut. Remove the diseased segment. Step 5.^—^Approximate the divided ends of the intestine. This is usuallypossible if mobilization has been sufficiently free. Moynihan urges that thor-ough mobilization of the splenic flexure, without injury to its vascular supply,is often necessary to secure approximation of the intestine after resection. Method A.—Restore the continuity of the gut by means of Murphys buttonor by the ordinary circular enterorrhaphy. Method B.—C. L. Gibsons method (Annals Surg., July, 1910). Seizethe upper cut edge of gut with two Kochers forceps and push it into the lumenof the lower end as far down as possible. Rotate the upper segment abouta quarter circle so that the non-peritoneal surfaces do not entirely the circumference. Introduce a sufficient number of Lembert sutures asshown in Fig. 589. When tying the sutures tuck in or invaginate the upperedge of the lower segment as shown in Fig. Fig. 590.—(C. L. Gibson.) Method C.—The diseased segment of gut has been delivered and its vesselsligated and divided as in Step 3, but the gut has not been divided. Makea lateral anastomosis between the afferent and efferent loops of gut. Doublyclamp the afferent segments between the anastomosis and the disease. Dividethe gut between the forceps. Close with sutures the open end of the gutnext the anastomosis; remove the clamp; invaginate the stump by means ofa purse-string suture or a line of Lembert sutures. Do the same with theefferent loop. Suture the two stumps to the parietal peritoneum. 432 OPERATIONS ON THE INTESTINES Method D.—If it has been necessary to remove the splenic flexure along withthe descending colon, close the open ends of the gut and make a lateral anas-tomosis between the transverse and the remnant of the descending colon orthe sigmoid. If the whole colon and caecum have been excised perform ileo-sigmoidostomy. Method E.—St
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