. A manual of gynæcology and pelvic surgery, for students and practitioners. Fig. 235.—Hemorrhoidectomy. Each tumor is picked up individually and itsmucocutaneous border incised. A simpler and better method is to burn away all the pro-truding tumor after preliminary incision of the muco-cutaneousborder and clamping. In the absence of a good cautery a simple ligature methodconsists in first drawing down the tumor and snipping throughthe muco-cutaneous junction; the pile is then clamped by oneor two haemostats applied well against its base and in the 522 DISEASES ASSOCIATED \^^TH GYNECOLOGIC LES
. A manual of gynæcology and pelvic surgery, for students and practitioners. Fig. 235.—Hemorrhoidectomy. Each tumor is picked up individually and itsmucocutaneous border incised. A simpler and better method is to burn away all the pro-truding tumor after preliminary incision of the muco-cutaneousborder and clamping. In the absence of a good cautery a simple ligature methodconsists in first drawing down the tumor and snipping throughthe muco-cutaneous junction; the pile is then clamped by oneor two haemostats applied well against its base and in the 522 DISEASES ASSOCIATED \^^TH GYNECOLOGIC LESIONS longitudinal axis of the body. A heavy thread is passed behindthe clamps so as to perforate the pile base at its middle and thisthread is tied in both directions, the tying being done as the clampis removed so that the ligature lies in the groove produced bythe instrument. If the tumor is very small nothing more needbe done; if larger it should be cut away sufficiently far from the. _ Fig. 236.—Hemorrhoidectomy. The skin is protected by moist sponges. Thepile is crushed at its base after incision of the mucocutaneous border. The entiretum^or is removed by the cautery. Hgature to avoid any danger of the latter slipping off the the tumors can be removed by either method, providingthey are all clamped longitudinally and a strip of normal mucosais left between the adjacent stumps. When the operation is completed the anus should be gentlyheld open to make certain that active bleeding has been con- HEMORRHOIDS 523 trolled, and a strip of iodoform gauze is introduced above thesite of operation with its outer end protruding through theanus. This gives immediate warning of post-operative bleedingand keeps the stumps apart. The post-operative treatment consists in the use of enoughmorphine hypodermically to prevent extreme pain and spasm
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