Operative surgery, for students and practitioners . aced in the abdominal cavity and the ends of the sutures, eachthreaded in a large, curved needle and carried through the corre-sponding edges of the peritoneum and transversalis fascia (posteriorlayer of the sheath of the rectus). The sutures are left untied untilthey have all been introduced. When the sutures are tied they havethe effect of securing the wall of the sigmoid against the peritoneumand at the same time they close the incision by drawing the edges ofthe peritoneum and transversalis fascia together. The edges of thesplit rectus ar
Operative surgery, for students and practitioners . aced in the abdominal cavity and the ends of the sutures, eachthreaded in a large, curved needle and carried through the corre-sponding edges of the peritoneum and transversalis fascia (posteriorlayer of the sheath of the rectus). The sutures are left untied untilthey have all been introduced. When the sutures are tied they havethe effect of securing the wall of the sigmoid against the peritoneumand at the same time they close the incision by drawing the edges ofthe peritoneum and transversalis fascia together. The edges of thesplit rectus are approximated with several sutures of plain edges of the aponeurosis of the external oblique are sutured witha continuous suture of chromic catgut and the skin finally closedwith an intracuticular suture of plain catgut. In cases of prolapse of the rectum the mesosigmoid is unusuallylong. This operation pulls the sigmoid and the rectum up taut andanchors the bowel to the anterior abdominal wall. OPERATIONS UPON THE ANUS AND RECTUM. 561. Fig. 250.—Sigmoidopexy. The anchor sutures which secure the wall of thesigmoid have been carried through the edges of the peritoneum and transversallsfascia. 562 EECTUM. The writer has used this plan in a considerable number of casesof long standing, intractable prolapse, in both children and adults,with uniform satisfactory results, and with no recurrences. Resection and Amputation of the Rectum.—Eesection of therectum consists in cutting away a portion of the rectal tube in con-tinuity. The operation is usually done for malignant disease;sometimes for syphilitic and tubercular disease, chronic ulceration,stricture, etc., where the disease is limited to the upper part of therectum (the ampulla part), the anal portion not being involved inthe disease. After the diseased part has been resected the upper endof the rectum is brought down and sutured to the lower, anal this operation the sphincter apparatus is not interfer
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