. Operative surgery. atureof the operation if desired from two steps to one, and perhapsin some cases to avoid it altogether, by this method of employ-ment at either aspect of the obstruction, of string friction. The Comments.—In the event of failure to dilate the stric-ture by way of the mouth the surgeon must supplement theeffort by the advantages arising from the performance of gas-trotomy or gastrostomy. The enfeebled condition of many ofthe patients with oesophageal stricture from lack of nourish-ment, and the tendency of obstinate strictures to relax aftera longer or shorter quiescence o
. Operative surgery. atureof the operation if desired from two steps to one, and perhapsin some cases to avoid it altogether, by this method of employ-ment at either aspect of the obstruction, of string friction. The Comments.—In the event of failure to dilate the stric-ture by way of the mouth the surgeon must supplement theeffort by the advantages arising from the performance of gas-trotomy or gastrostomy. The enfeebled condition of many ofthe patients with oesophageal stricture from lack of nourish-ment, and the tendency of obstinate strictures to relax aftera longer or shorter quiescence of the tube, have led to increasedfrequency of employment of the latter plan, in order to permit of ample andimmediate nutrition and to afford the rest to the oesophagus essential to stric-ture relaxation. Silver regards those cases characterized by impassable stric-ture and pronounced regurgitation—the latter indicating decided pouching ofthe oesophagus—as suitable for prompt gastrostomy. Cancer of the oesopha-. FiG. 856. String friction appliance. OPERATIONS ON THE ESOPHAGUS. 67Y gus, especially, calls for early relief by this method. The opening into thestomach should be made of sufficient size to admit one or two fingers alongwith the necessary instrument for dilatation, and be placed well up on theanterior surface to permit of as easy access to the cardiac orifice as possible,and also to limit the danger of leakage during the manipulation. The bor-ders of the gastric opening can be drawn apart by traction loops, to affordbetter observation, or they may be drawn by the loops closely against theexploring agent, thus lessening the danger of escape of the contents of thestomach. This opening may be closed independently of the abdominal one,provided dilatation sufficient to allow the ready passage of fluid food and theemployment of bougies from above have taken place. The dilatation shouldbe completed at a single sitting, if possible. If preliminary gastrostomy beperformed
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