. American practice of surgery ; a complete system of the science and art of surgery . ylong to be carried down into the anal opening and sutured there, the lower seg-ment may be everted before or after the tunior has been excised, and an end-to-end suture made outside the anus. SURGICAL DISEASES OF THE ANUS AND RECTUM. 917 Another way of treating the ends, that of Hochenegg, is to dissect the mu-cous membrane off the lower segment, invaginate the end of the upjDcr seg-ment through this freshened tube, and suture it to the skin. If resection isdone when the tumor is removed, the two ends may b
. American practice of surgery ; a complete system of the science and art of surgery . ylong to be carried down into the anal opening and sutured there, the lower seg-ment may be everted before or after the tunior has been excised, and an end-to-end suture made outside the anus. SURGICAL DISEASES OF THE ANUS AND RECTUM. 917 Another way of treating the ends, that of Hochenegg, is to dissect the mu-cous membrane off the lower segment, invaginate the end of the upjDcr seg-ment through this freshened tube, and suture it to the skin. If resection isdone when the tumor is removed, the two ends may b(! united b\- cnd-to-endsuturing (Fig. 381), by a Murphy button, oi-, as advised liy Kocher, by unitingthe ends throughout two-thirds of their circumfei-ence and leaving the post(!-rior third open. The writer has seen only four eases in which resection hasnot been followed by fistula; all these, nevertheless, healed, but he has neverbeen convinced of the wisdom of suturing the bowel half way around. If acomplete circular suture is employed there will probably be a fistula, but this. Fig. 380.—Fourth Step in Bone-flap Extirpation of the Rectum. /?, Rectum; £■, site of recto-vesical cul-de-sac; Si, sigmoid; P, peritoneal ca\at3 closed by sutures. (Tuttle: Diseases of theRectum, Anus, and Pehnc Colon. D. Appleton & Co., New York.) will be smaller and will be more likely to heal than if it involves one-half ortwo-thirds of the circumference of the bowel. As to the use of the Murphy button in these cases, it is certain!} a conven-ience, but not a more {perfect method of securing apposition than is the planof applying sutures. Furthermore, as in the latter plan, it is follo^ved by theestablishment of a fistula. After the ends of the intestine have been disposed of, it is well to carry alarge silk suture through the meso-rectum and to tie it to a fixed portion of themargin of the wound, thus anchoring the bowel as a whole and so preventingtoo much tension on the ends w^hich have
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectsurgery, bookyear1906
