. Diseases of the gall-bladder and bile-ducts, including gall-stones . e Bobbin Operation. united by interrupted catgut stitches, after which the circleof catgut stitches and then the circle of serous sutures iscompleted. If the bone bobbin be used, two continuous sutures onlyare employed : a silk stitch to unite the serous surfaceJ or ^ inch from the visceral openings, and a catgut sutureto join the mucous margins of the visceral openings. For convenience, the posterior semicircle of the seroussuture is first applied, and the needle laid aside for a moment, 286 DISEASES OF THE GALL-BLADDER AN
. Diseases of the gall-bladder and bile-ducts, including gall-stones . e Bobbin Operation. united by interrupted catgut stitches, after which the circleof catgut stitches and then the circle of serous sutures iscompleted. If the bone bobbin be used, two continuous sutures onlyare employed : a silk stitch to unite the serous surfaceJ or ^ inch from the visceral openings, and a catgut sutureto join the mucous margins of the visceral openings. For convenience, the posterior semicircle of the seroussuture is first applied, and the needle laid aside for a moment, 286 DISEASES OF THE GALL-BLADDER AND BILE-DUCTS but not unthreaded; the openings are then made, and theposterior half of the mucous suture is inserted. The bobbinis then introduced, and the mucous suture continued arounduntil it meets the other end of the catgut, when the twoends are tied and cut off short; the serous suture is thencarried around the anterior half until it reaches the pointwhere it began, when the two ends are drawn on and tied.(Figs. 49 and 50.) The bobbin keeps open the lumen until. Fig. 50.—Diagram to show Application of Serous Suture in theBone Bobbin Operation. it is dissolved, and the mucous and serous sutures effectuallyprotect the channel from leakage. If the Murphy button be used, the smallest size is selected,and two running sutures are applied, as shown in the the gall-bladder has been emptied, and the bowelclamped either by Murphys intestinal clamps or Lanesclamps, or by a simple elastic tourniquet, the openings aremade in the viscera just sufficiently large to admit theseparate ends of the button. The threads are then drawn onand tied around the central barrel of the button (Figs. 51 GALL-STONES, OR CHOLELITHIASIS 287 and 52), after which the two ends of the button are ap-proximated and pushed home firmly. The anastomosis isthen complete. The whole process occupies a very short time, and is reallyvery simple. It is, however, necessary to bear in mind thatthe button h
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