. Diseases of the rectum and anus: designed for students and practitioners of medicine. n the rectum and vagina is large andhigh up, operative procedure must be resorted to. In somecases the sinus will heal by granulation after simple incisionand curettage. The best results, however, have followed whenthe sinus has been dissected out and the rectal and vaginalsurfaces closed by separate rows of sutures. In doing thisoperation it is necessary to split the recto-vaginal septum, care 264 DISEASES OF THE RECTUM AND ANUS being taken to avoid removing more tissue than is absolutelynecessary. In Rect
. Diseases of the rectum and anus: designed for students and practitioners of medicine. n the rectum and vagina is large andhigh up, operative procedure must be resorted to. In somecases the sinus will heal by granulation after simple incisionand curettage. The best results, however, have followed whenthe sinus has been dissected out and the rectal and vaginalsurfaces closed by separate rows of sutures. In doing thisoperation it is necessary to split the recto-vaginal septum, care 264 DISEASES OF THE RECTUM AND ANUS being taken to avoid removing more tissue than is absolutelynecessary. In Recto-vulvar and Recto-labial Pistulse the sinus may belaid open by an incision at a right angle to the sphincter, afterwhich the tract is dissected out; the wound is closed by buriedsutures and the sphincter united as in perineorrhaphy. Thisform of fistula may sometimes be cured by: (a) laying thesinus open and allowing it to heal by granulation; (b) passingan elastic ligature through the sinus and tying it so as to in-clude all of the tissue within its grasp, after which it is allowed. Fig. 84.—Method of Using Gants Grooved Director. Third Step. to cut its way out; or (c) keeping it clean and cauterizing itswalls, as often as may be necessary, with stick silver. Eecto-veslcal Fistula rarely heals spontaneously. The opera-tions for the relief of this condition, when congenital, havebeen discussed elsewhere. When due to stricture, tubercularor malignant disease, very little can be accomplished by localoperations, and, the sooner a colostomy is made, the better itwill be for the sufferer. An artificial anus gives marked reliefand frequently an extension of life by permitting free exit ofthe feces, thus preventing their entrance to the bladder andurethra and obviating the suffering. Recto-vesical fistula can be cured occasionally by irriga- TREATMENT OF ANORECTAL FISTULA 265 tion of both bladder and rectum, cauterization, regulating thestools, keeping a tube in the rectum to preven
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectanusdis, bookyear1910
