Modern surgery, general and operative . attached to a bougie, and the dilating instrument is pulled upthrough the esophagus. Forcible dilatation can be employed through agastrotomy opening, by means of bougies, tents, or di\adsing fibrous stenosis in the region of the cricoid cartilage which is not curedby gradual dilatation should be treated by the operation of external esoph-agotomy. In this operation the stricture is di\ided by a longitudinal incision;funnel-shaped retraction of the cut portion is caused by adhesion to the 936 Diseases and Injuries of the Upper Digestive Tract
Modern surgery, general and operative . attached to a bougie, and the dilating instrument is pulled upthrough the esophagus. Forcible dilatation can be employed through agastrotomy opening, by means of bougies, tents, or di\adsing fibrous stenosis in the region of the cricoid cartilage which is not curedby gradual dilatation should be treated by the operation of external esoph-agotomy. In this operation the stricture is di\ided by a longitudinal incision;funnel-shaped retraction of the cut portion is caused by adhesion to the 936 Diseases and Injuries of the Upper Digestive Tract external tissues divided, and it lessens future contraction.^ If dilatation failsin the case of a stenosis anywhere above the line of the aortic arch, the esoph-agus may be opened above the stricture (external esophagotomy). If thestricture is below the wound a tenotome may be introduced through thewound, the stricture is cut and well dilated by the passage of operation is known as Gussenbauers combined Fig- 593-—Abbes method of cutting esophageal strictures. If a stricture is impassable from above, the stomach should be openedand retrograde dilatation be carried out. Billroth showed years ago that a stric-ture impassable from above may be passable from below. This is because theesophagus above the stricture is basin shaped and immediately below thestricture is fimnel shaped (Abbe). If a fine bougie is carried from the stomachto the mouth it is used to carry a piece of string through the same route, andthis string is used to pull bougie after bougie through the strictm-e. A firm,non-dilatable stricture in the thoracic portion of the esophagus can be treated by Abbes method (; 594)- He performsa gastrotomy, sutures thestomach to the abdominalwound to prevent contam-ination of the peritonetmi,and seeks for the esophagealopening by two fingers passedwithin the stomach. Abbepoints out that finding theorifice would seem muchmore easy than i
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