. Diseases of the rectum and anus: designed for students and practitioners of medicine. iallyadapted for such cases (Figs. 79 and 80). There is a knobon the under-surface of the lower blade of the scissors whichis made to follow in the oval groove in the director, cuttingthe tissues from without inward. Another and a better waywhen the sinus reaches high up in the bowel, or when othersinuses are suspected, is to dissect slowly from below upward,following the director until the end of the sinus is reached; 260 DISEASES OF THE RECTUM AND ANUS then any diverticula from the main sinus will not be
. Diseases of the rectum and anus: designed for students and practitioners of medicine. iallyadapted for such cases (Figs. 79 and 80). There is a knobon the under-surface of the lower blade of the scissors whichis made to follow in the oval groove in the director, cuttingthe tissues from without inward. Another and a better waywhen the sinus reaches high up in the bowel, or when othersinuses are suspected, is to dissect slowly from below upward,following the director until the end of the sinus is reached; 260 DISEASES OF THE RECTUM AND ANUS then any diverticula from the main sinus will not be over-looked. The sphincter-muscles. should not be severed in fistulaoperations oftener than is absolutely necessary; they may becut one, tzvo, or three times, however (Fig. 93), when neces-sity demands, and incontinence will not follow, especially if theincisions are superficial. It is the high incisions which, bydividing both the external and internal sphincters, cause fecalincontinence. Goodsall lays special stress upon the danger ofincontinence when the internal sphincter is Fig. -Proper Method of Using Allinghams Scissors and Director. The principle features of the operation for complete fistulaare apphcable to the other forms, but the technic must be variedto suit the case. Blind External Fistula is operated upon by inserting thegrooved director into the sinus as far as possible; then it isforced through into the rectum, and the operation finished asin complete fistula. Blind Internal Fistula is more difificult to operate upon thanis the one just described, because the sinus is frequently tort-uous and may take any direction, thus rendering it extremelydifificult to insert the director and incise it. When the opening TREATMEMT OF ANO-RECTAL FISTULA 261 is near the anus and the sinus passes directly or obhquely up-ward beneath the mucous membrane, the director should bepassed to the upper limit of the tract, pushed through the mu-cosa, and the membrane divided along t
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectanusdis, bookyear1910
