Gynecology . ing abovethe plane of the clamp is burned off with the actual cautery kept at a moderatedull-red heat. In this way the principal hemorrhoids are removed. There ismore danger from postoperative hemorrhage after this operation than from theother two methods described. The after-treatment should be the same and aslong continued after this operation as after the others. 712 GYNECOLOGY FISTULA IN ANO The surgical treatment of fistula in ano consists either of incision of thetract and open treatment of the wound, or of dissection of the fistulous tractwith partial closure and drainage o
Gynecology . ing abovethe plane of the clamp is burned off with the actual cautery kept at a moderatedull-red heat. In this way the principal hemorrhoids are removed. There ismore danger from postoperative hemorrhage after this operation than from theother two methods described. The after-treatment should be the same and aslong continued after this operation as after the others. 712 GYNECOLOGY FISTULA IN ANO The surgical treatment of fistula in ano consists either of incision of thetract and open treatment of the wound, or of dissection of the fistulous tractwith partial closure and drainage of the wound. By the first method a director is passed through the fistulous opening andout through the anal orifice (Fig. 418). The tissues are then slit with a sharpknife carried along the groove of the director. In this way a part of the sphinctermuscle is always cut. This may do no harm if only the external fibers are , however, the internal fibers are severed, fecal incontinence is likely to Fig. 418:—Fistula in Ano. Open Method of director is .introduced into the fistulous tract and an incision made along the director. Theopen wound is packed and allowed to granulate. In making the incision, fibers of the sphinctermuscle are severed to a greater or less extent. The wound is packed and kept open with iodoform gauze for a week or so,when it is allowed to heal. In some cases the open method just described is theonly one feasible, especially in those cases where the surrounding tissue is under-mined and unhealthy. In the majority of cases seen in gynecologic clinics the dissection method isentirely feasible and preferable. The authors technic is as follows: The fistulous tract is first explored with a fine probe to determine its direc-tion, whether it is simple or complex, and whether or not it communicates with OPERATIONS ON THE RECTUM 713 lumen of the bowel. A director is then introduced, being brought out throughthe anal orifice if there is a de
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