The practice of surgery . Fig. 222.—Vesicovaginal fistula (diagrammatic). VAGINAL 355 be supplied copiously. The bowels should be regulated stitches should remain in place for at least twelve days. With allthese precautions even, union may not always take place, and a slightfistula may recur. In such case, on three occasions, I have finally andsatisfactorily closed the trifling leak by injecting melted paraffin intothe tissues about the fistula, thus bringing about union by pressure. The second form of vesicovaginal fistula—the great irregular,indurated opening—demands o
The practice of surgery . Fig. 222.—Vesicovaginal fistula (diagrammatic). VAGINAL 355 be supplied copiously. The bowels should be regulated stitches should remain in place for at least twelve days. With allthese precautions even, union may not always take place, and a slightfistula may recur. In such case, on three occasions, I have finally andsatisfactorily closed the trifling leak by injecting melted paraffin intothe tissues about the fistula, thus bringing about union by pressure. The second form of vesicovaginal fistula—the great irregular,indurated opening—demands often a serious and extensive number of different methods, many of them extremely ingenious,have been devised, such as these of R^dygier, IMartin, Trendelenburg,Sanger, Walcher, von ^yinkel, Mackenroth, Kelly, Kiistner, and describes the details of these procedures, and I refer the reader. Fig. 223.—Suprapubic operation for vesicovaginal fistula (.Trendelenburg), sagittalsection. Suprapubic incision seen above (Kelly). to his Operative Gynecology, vol. i, p. 336. For myself I have securedgratifying results through the employment of von Dittels method, whichfollows the principle of all the others; that is to say, by some means oneseparates the bladder from the vagina and repairs the several rents ofthe organs independently. I advocate opening down upon the bladderfrom above the pubes and isolating the bladder without opening theperitoneum if possible. Often this is possible, but if not, one must gothrough the abdominal cavity, and in any case the dissection is facili-tated by tipping up the patient on a Trendelenburg table. Rectovaginal fistula is less common than vesicovaginal fistula,but it is even more distressing. The diagnosis is readily made by ob-serving the contents of the rectum oozing from the vagina. The patient 356 FEMALE ORGANS OF GENERATION herself also w
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1910
