Fig. 580
Antiperistaltic lateral apposition (bad).
All that has been said above with regard to the Murphy button and its use in anastomotic operations holds equally good here with regard to its usefulness after resection.
Numerous devices, either instruments for the purpose of holding the bowel together while it is sutured, or of affording substitutes for the Murphy button, have been planned by operators all over the world. There are few of them, however, which give any better results than the simple methods above described, to which I prefer to limit description here because of their very simplicity.
Intestinal suture or any other method of completing the resection having been finished, a careful toilet of all exposed parts should be made, by which bowel may be dropped back into the abdominal cavity and the latter closed without drainage.
The subsequent management of these cases will consist in two or three days’ starvation, in order that peristalsis may be reduced to a minimum, the patient being meanwhile fed by the rectum. Then will come a time when both fluid food, and cathartics a little later, should be gently and discriminately administered. Any satisfactory suture method will rarely give way after forty-eight hours. Buttons, on the contrary, may break loose after many days or even weeks, and this fact affords another argument against their use.
Fig. 581
Enterostomy; preliminary fixation of a loop of bowel to the peritoneum. (Lejars.)