. Diseases of the rectum and anus: designed for students and practitioners of medicine. served 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, i
. Diseases of the rectum and anus: designed for students and practitioners of medicine. served 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 cases/ and has been much pleased with the his opinion, it should take precedence over the operationsof Kocher and Kraske in all cases in which the growth is sosituated that it can be removed from in front. The advantages of vaginal proctectomy are tersely givenby Murphy, of Chicago, as follows:— 1. The sacrum and posterior bony wall of the pelvis arenot Fig. 1S2.—Proctectomy by tlie Vagina Route. 2. The field of operation is extensive and the anatomicparts are accessible as in the transsacral operation. 3. The peritoneal cavity is opened in both the vaginal andsacral operations, and in neither is it a source of great danger. 4. The diseased tissue is more accessible for inspection, andthe extent to which an operation may be carried in an upwarddirection is as great, if not greater, than by the sacral route. 5. The peritoneum may be drained freely through thevagina. 6. A perfect end-to-end approximation, either by suture » These operations were all performed before January, 1905. Since then he has performedother operations of the same kind. 568 DISEASES OF THE RECTUM AND ANUS or by the use of the button, may be secured. The preferablemethod of uniting the two ends is by interrupted sutures ofsilk; as there is no peritoneum on the sphincteric seg
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectanusdis, bookyear1910
