. Diseases of the rectum and anus: designed for students and practitioners of medicine. ated within three to five inches ( centimeters to ) above the anus in the female it will be found advan-tageous to amputate or resect the rectum by the vaginal route,since this operation avoids bony mutilation and destruction ofthe pelvic support. The operation can be performed in a com-paratively short time. The mortality following it is very small. 566 DISEASES OF THE RECTUM AND ANUS The operation is performed in three steps, as follows:— 1. A longitudinal median incision of sufficient le
. Diseases of the rectum and anus: designed for students and practitioners of medicine. ated within three to five inches ( centimeters to ) above the anus in the female it will be found advan-tageous to amputate or resect the rectum by the vaginal route,since this operation avoids bony mutilation and destruction ofthe pelvic support. The operation can be performed in a com-paratively short time. The mortality following it is very small. 566 DISEASES OF THE RECTUM AND ANUS The operation is performed in three steps, as follows:— 1. A longitudinal median incision of sufficient length ismade in the posterior vaginal wall and carried down throughthe perineum. If this does not give sufficient room, a trans-verse incision is made just below the cervix and the flapsturned to either side. 2. An incision is made encircling the anus half an inch( centimeters) or more from its margin (Fig. 181). Therectum is then freed from its attachments, brought forwardthrough the vaginal incision, dissected upward beyond thegrowth, and the lower bowel amputated (Fig. 182).. Fig. 181.—Proctectomy by the Vaginal Route. 3. The remaining end of the rectum is brought down andsutured to the skin around the circular incision, the vaginalwound is closed with silk-worm, wire, or catgut sutures (), and dressings applied. When possible, the sphincters should be preserved and anend-to-end anastomosis made in the manner described in dis-cussing superior and inferior proctectomy. When the diseasehas destroyed the lower rectum, the proximal end should betwisted, as suggested by Gersuny (Fig. 182), before attaching itto the skin, in order to produce partial continence of feces. Theperitoneum when injured may be drained by means of gauzeplaced behind the rectum or introduced through the vagina; or, TEEATMENT OF MALIGNANT TUMORS 567 if there is little danger of infection, it may be closed by suturingit to the bowel. The author has performed vaginal proctectomy in six se-lected
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectanusdis, bookyear1910
