. American practice of surgery ; a complete system of the science and art of surgery . nd string,to the lower end of which a Billroth dilating bougie istied, and by means of this string the bougie is drawnupward until it becomes tightly engaged in the stric-ture; the sawing process may then be employed inthe manner described fundamental principle of this operation is this: the dilator must bepressed tightly into the stricture in order that the string moving to and fro mayeat its way through the stricture. No tissue will be affected by the string,except where it is on the stretch. The
. American practice of surgery ; a complete system of the science and art of surgery . nd string,to the lower end of which a Billroth dilating bougie istied, and by means of this string the bougie is drawnupward until it becomes tightly engaged in the stric-ture; the sawing process may then be employed inthe manner described fundamental principle of this operation is this: the dilator must bepressed tightly into the stricture in order that the string moving to and fro mayeat its way through the stricture. No tissue will be affected by the string,except where it is on the stretch. The gastrotomy opening may be closed immediately after the cuttingprocess is completed, or it may be left open for a few days until it is demonstratedthat a large-sized bougie may be readily passed from above. Bougies should bepassed every other day at first, then weekly, then once a month for a year, andafter that once each year. In some cases it is possible to pass a small-sized bougie through the stricturefrom above, but these strictures are so dense that they will not yield to the. Fig. 180.—Abbes String-cutting Method. The dilatingbougie and string are in place. SURGICAL DISEASES OF STOMACH AND (ESOPHAGUS. 437 bougies. For such a case, Dr. Joseph D. Hiyaiit dcNiscd a small bcnigic ihatcarried a string around the advancing end down IVoin above through thestricture for the purpose of cutting the latter by the string method withoutperforming a gastrotomy. Abbe- modified this bougie in such a manner asto make its use more simple and practical. He devised a dilating metal guidewhich carries a string down to the face of the stricture and back again, so that,working entirely from the patients mouth, he was able to wear a passagethrough the strictinv on the same principle that applies in his original string-cutting operation. The patients head is held back in a position which willrender the oesophagus as straight as possible. The instrument is gently pushed
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectsurgery, bookyear1906
