. Modern surgery, general and operative. h., Feb. 20, 1902. Stricture of the Esophagus 1065 yet it will not be pulled out. The thread may remain in place for some time,dilating the stricture. It may be used as a guide to direct a bougie through atight or tortuous constriction, the eyed bougie being threaded upon the strand(Plummer, in Collected Papers of the Mayo Staff in Rochester, 1911). If thestenosis involves a considerable portion of the esophagus, gradual dilatationwill almost certainly fail to cure. Symonds advocates the insertion of a tube through the stricture and leav-ing it in place
. Modern surgery, general and operative. h., Feb. 20, 1902. Stricture of the Esophagus 1065 yet it will not be pulled out. The thread may remain in place for some time,dilating the stricture. It may be used as a guide to direct a bougie through atight or tortuous constriction, the eyed bougie being threaded upon the strand(Plummer, in Collected Papers of the Mayo Staff in Rochester, 1911). If thestenosis involves a considerable portion of the esophagus, gradual dilatationwill almost certainly fail to cure. Symonds advocates the insertion of a tube through the stricture and leav-ing it in place until there is decided dilatation, and then replacing the tube witha larger instrument. The patient is fed through the tube (Fig. 678). Insome cases in which it is impossible to pass a bougie through the strictureby the ordinary plan it is possible to pass one when viewing the opening throughthe stricture by means of the esophagoscope. Whalebone or olive-tipped in-struments may be passed in increasing sizes. Strands of silkworm-gut may. Fig. 679.—Abbes method of cutting esophageal strictures. be passed. If they are, they can be left in place a few hours, when a largerbundle of gut or perhaps an instrument can be passed. Surgeons have divulsedstrictures and performed internal esophagotomy through an of these plans is preferable to forcible dilatation or internal esophagotomyby a special instrument, but without the esophagoscope. Electrolysis has been advocated by Fort and others. Gradual dilatationfrom below has been practised in cases in which a bougie could not be passedfrom the mouth. A gastrostomy is performed, and after the fistula has becomesound the patient is made to swallow a shot to which is attached a silk thread(Maylard). The silk thread is brought out through the fistulous orifice andis attached to a bougie, and the dilating instrument is pulled up throughthe esophagus. Forcible dilatation can be employed through a gastrotomyopening, by means
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