. Diseases of the rectum and anus: designed for students and practitioners of medicine. sharp bistoury, with one stroke, cut downthrough the fissure and divide the muscle. The cut should ex-tend a little way beyond the ends of the ulcer, but not so highas to sever the internal sphincter, because of the added dangerof incontinence. The danger of this accident is emphasized bythe opponents of this operation, but in the authors experience In most of his cases, the anthor prefers to divide the muscle under local anesthesia. TREATMENT OF ANAL FISSURE 315 incontinence has never followed division of
. Diseases of the rectum and anus: designed for students and practitioners of medicine. sharp bistoury, with one stroke, cut downthrough the fissure and divide the muscle. The cut should ex-tend a little way beyond the ends of the ulcer, but not so highas to sever the internal sphincter, because of the added dangerof incontinence. The danger of this accident is emphasized bythe opponents of this operation, but in the authors experience In most of his cases, the anthor prefers to divide the muscle under local anesthesia. TREATMENT OF ANAL FISSURE 315 incontinence has never followed division of the sphincter forthe relief of fissure; he has, however, treated several personsfor loss of sphincteric control caused by sudden stretching ofthe muscle by mechanic dilators. Dumarquay has suggested submucous division of thesphincter-muscle; but his operation has not met with favor,principally because it is frequently followed by infection, ab-scess, and fistula. Excision is preferred by some operators, but the authorhas not found it as effective as either divulsion or division. It. Fig. 95.—Gants Large Operating Speculum. consists in circumscribing the ulcer by elliptic incisions and re-moving it. The wound is then closed with catgut sutures oris allowed to heal by granulation. In addition to excising theulcer, the writer always divides or divulses the sphincter-musclein order that complete rest of the parts may be assured. Ex-cision and immediate closure of the wound when successfuleffect a cure more quickly than any other operation for fissure,but when infection of the wound takes place increased painand abscess follow. When the fissure is due to laceration and downward dis-placement of a semilunar valve, forming the so-called sen- 316 DISEASES OF THE RECTU]VI AND ANUS tinel pile, Ball suggests that the latter be removed by a V-shaped incision, having the base toward the ulcer, so that noth-ing is left which can be caught by a passing fecal mass. Theulcer should be curette
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectanusdis, bookyear1910
