. Annals of surgery . the same reason. It seemed best,therefore, as already described, to utilize a portion of the pouchto furnish a new posterior wall to the oesophagus at the level ofthe constriction (Figs. 9 and 10). Of the treatment of oesophageal diverticula. Von Ziemssenand Zenker wrote in 1878 (see Cyclopaedia of the Practiceof Medicine, by Von Ziemssen, Vol. viii, page 89) : The radical cure of diverticula by operative procedurefrom without is at the present time one of our vain wishes;36 542 MAURICE H. RICHARDSON. yet we should hope that even this operation, conducted onListers plan,
. Annals of surgery . the same reason. It seemed best,therefore, as already described, to utilize a portion of the pouchto furnish a new posterior wall to the oesophagus at the level ofthe constriction (Figs. 9 and 10). Of the treatment of oesophageal diverticula. Von Ziemssenand Zenker wrote in 1878 (see Cyclopaedia of the Practiceof Medicine, by Von Ziemssen, Vol. viii, page 89) : The radical cure of diverticula by operative procedurefrom without is at the present time one of our vain wishes;36 542 MAURICE H. RICHARDSON. yet we should hope that even this operation, conducted onListers plan, might at some future day be performed withoutdanger. Nothing is to be hoped from attempts to destroy thediverticula by the introduction of astringent or irritating ma-terials through the pharynx,—at least from our experiencethus far, and from observation of the fact that we cannot, bycompression or any other procedure, prevent the entrance offood, or of mucus and saliva, into the diverticulum, even for ashort Fig. io.—Showing oesopnugus and pharjnx after vertical suturino; of the pouchopening and transverse suturing of the cesophageal slit. Case II. The vain hope of Ziemssen and Zenker has become areality: in the last twenty years some seventeen cases havebeen operated upon. Of these all have been successful butone. In the earlier operations the oesophageal wound was keptopen with a drainage-tube. In the later operations the oesopha-gus has been immediately closed, the outer wound being packedtemporarily with gauze. In one instance only have oesophagus (ESOPHAGEAL DIVERTICULUM. 543 and outer wound been immediately sutured; and this is theonly case in which the wound has healed by first theoretical grounds there should be no greater dangers ofextravasation in suture of the oesophagus than in suture ofthe intestine, except, perhaps, that the inverted tissues of theoesophagus do not adhere together so quickly and so firmlyas the approximated peritoneal surf
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