A new method of performing circular enterorrhaphy / by F.T. Paul.

  • Paul, F. T. (Frank Thomas), 1851-1941.
Date:
[1891]
Catalogue details

Licence: Public Domain Mark

Credit: A new method of performing circular enterorrhaphy / by F.T. Paul. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    and the mesentery should not be allowed to drag in the least degree from the cut edge of the bowel. Next, the needle of the traction thread is slipped along a director, about 3 inches down the distal segment of the bowel, and pushed through its wall. Then the distal is sewn to the proximal end by a chromic gut suture all round, the needle piercing the musculo-serous coats only. Again, great care is taken to fix the mesenteric edge securely, and, with the same thread, the opening in the mesentery is drawn together. Now an assistant takes the traction-threads and steadily resists the operator as he draws the distal end of the bowel back over the tube, thus invaginat- ing the proximal end and producing the appearance seen in figure C. The parts are retained in position by a few Lembert sutures, one on either side of the mesentery, and others as they appear necessary. Lastly, the traction-thread is pulled tight and cut off short, the small opening caused by it requiring no further attention. The operation is completed by cleansing the intestine and closing the abdomen in the usual way. The special part of the operation may be said to involve three stages: first, to introduce the bone tube into the upper or proximal end of the bowel, and sew it there; second, to pass the traction-thread and attach the distal and proximal ends together; third, to produce the invagination, retain it in posi- tion by a few Lembert sutures, and cut off the traction-thread. With no unusual difficulty, each stage ought only to occupy a few minutes. I operated in this way upon six more dogs, and they all did remarkably well. Three I killed, at short intervals after the operation, to examine the condition of the bone tubes and the stages of repair. They were in excellent health at the time of being killed, it having been arranged beforehand how long each dog was to live after the operation. This was carried out in all but one, which should have been killed on the third instead of the fourth day. These dogs were allowed more food than the first two, bread and milk being given the day after operation. Nearly all passed a motion daily, showing that the tube offered little or no obstruction to the passage of food. They were not tied up,