. Gynecology : . dissection is carried to the white line, which indicates the 828 GYNECOLOGY insertion into the rectum of the levator ani muscle. By this dissection all con-nection of the bowel with the fistulous tract is severed. The external openingor openings are then dilated and the fistulous tract in all its ramifications thor-oughly cureted, care being taken not to injure the sphincter muscle. The freemargin of bowel made by the first dissection is now trimmed off above the levelof the internal fistulous opening, and the edge of the upper segment of bowelunited to the skin of the anus by
. Gynecology : . dissection is carried to the white line, which indicates the 828 GYNECOLOGY insertion into the rectum of the levator ani muscle. By this dissection all con-nection of the bowel with the fistulous tract is severed. The external openingor openings are then dilated and the fistulous tract in all its ramifications thor-oughly cureted, care being taken not to injure the sphincter muscle. The freemargin of bowel made by the first dissection is now trimmed off above the levelof the internal fistulous opening, and the edge of the upper segment of bowelunited to the skin of the anus by interrupted sutures of fine silk or catgut, as inthe Whitehead operation for hemorrhoids. The external fistulous opening islightly packed with gauze. The bowels are moved in two days. The externalopenings heal gradually by granulation. VARICOSE VEINS OF THE LEG There are numerous operations employed for the cure of varicose veins, allof them more or less subject to failure. Of these may be mentioned the circular. ft- Fig. 488.—Mayos Operation for Varicose the manner of making the incisions. incision of Schede; multiple incision and ligation; Trendelenburgs resection of aportion of the internal saphenous vein in -the upper thigh; complete dissection ofthe vein by long incision, and Mayos subcutaneous enucleation with a speciallydevised instrument. Of these, the Trendelenburg operation is the simplest, and can be used in OPERATIONS ON THE RECTUM 829 many cases, especially in those which are complicated with a varicose ulcer. TheSchede operation, once popular, is at present comparatively little used. Multipleincision and ligation is a long and tedious operation, but in some cases must beresorted to. Complete dissection of the vein is a long operation and entailstoo great a risk in the event of sepsis, which, in view of the extremely long wound,constitutes a grave danger. In the majority of cases the subcutaneous enuclea-tion by Mayos method is, in our e
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