. American practice of surgery ; a complete system of the science and art of surgery . sses through the peritoneum and muscular wall. Fourlong hea\y silk ligatures are then passed through the walls of the cut end ofthe sigmoid, at equidistant points, and are fimily twisted together so as toform a rope: this step practically closing the aperture. A longitudinal incision, 924 AMERICAN PRACTICE OF SURGERY. about one inch in length, is then made in the anterior wall of the rectum; along forceps is carried through the anus and brought out through this incision;by means of its blades the long suture
. American practice of surgery ; a complete system of the science and art of surgery . sses through the peritoneum and muscular wall. Fourlong hea\y silk ligatures are then passed through the walls of the cut end ofthe sigmoid, at equidistant points, and are fimily twisted together so as toform a rope: this step practically closing the aperture. A longitudinal incision, 924 AMERICAN PRACTICE OF SURGERY. about one inch in length, is then made in the anterior wall of the rectum; along forceps is carried through the anus and brought out through this incision;by means of its blades the long sutures attached to the sigmoid are graspedand this organ is dragged down into the rectum, thus invaginating the edges ofthe wound which are covered with peritoneum and making a wide appositionbetween this and the peritoneal covering of the sigmoid. (Fig. 389.) Thetwisted sutures are caught by a pair of forceps, or wrapped around a small rollof bandage and rotated until they hold the sigmoid well in place. The clampor the ligature on the sigmoid is now removed, and one may add a few Lem-. FiG. 387.—Restoration of Bowel in Vaginal Extirpation of the Rectum. (Murphy.) bert sutures at the junction, in order more firmly to secure the colon in having been accomphshed, the raw surfaces in the peritoneal cavity arecovered as well as possible, and the abdomen is closed. The writer has donethis operation four times successfully. In one case there was a stricture at thepoint of exit of the colon into the rectum; this was overcome by passing along pair of pressure forceps through the anus, with one prong in the rectalcul-de-sac and one in the sigmoid, thus cutting through the septum by pressure.(Fig. 342.) The results were all that could be desired. (e) Combined Operation.—When the tumor is situated in the highest por- SURGICAL DISEASES OF THE ANUS AND RECTUM. 925 tion of the rectum and the lower sigmoid, it is often advantageous to loosenit from its attachments through the ab
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