. Diseases of the gall-bladder and bile-ducts, including gall-stones . the decalcified bone bobbin. (c) By means of Murphys button. My first case, in 1889, was performed by suture, mysecond and third by means of the decalcified bone bobbins,and in all my later cases the Murphy button has been in the cases unassociated with cancer all exceptone recovered, it is decidedly preferable to make the unionby means of the Murphy button, both on account of itsefficiency and the expedition with which it can be used. GALL-STONES, OR CHOLELITHIASIS 285 The operation of cholecystenterostomy is
. Diseases of the gall-bladder and bile-ducts, including gall-stones . the decalcified bone bobbin. (c) By means of Murphys button. My first case, in 1889, was performed by suture, mysecond and third by means of the decalcified bone bobbins,and in all my later cases the Murphy button has been in the cases unassociated with cancer all exceptone recovered, it is decidedly preferable to make the unionby means of the Murphy button, both on account of itsefficiency and the expedition with which it can be used. GALL-STONES, OR CHOLELITHIASIS 285 The operation of cholecystenterostomy is performedthrough the same incision as is made for cholecystotomy,and after the gall-bladder has been aspirated and the in-testine clamped, if thought necessary, either by an india-rubber tourniquet or by intestinal clamps, the junction iseffected. If sutures be employed, a semicircle of interruptedsilk stitches is inserted to unite the contiguous serous sur-faces of the gall-bladder and gut; the viscera are thenopened, and the mucous margins of the two openings are. Fig. 49.—Diagram to show Application of Mucous or Marginal Suturein the Bone 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 ante
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