. Surgery, its principles and practice . and transform-ing this deficient anus, bytwisting the bowel onehalf-turn or more beforestitching, to make a spiralend to the outlet in hopesof its being more manage-able. This addition hasiDeen generally abandonedas giving an improvementin but a small number ofcases, and adding a riskof infection and of gan-grene of the end. The ideal to be at-tained is restoration ofthe canal without tension,and with a continuedsphincteric anus. Tworeasons often preventthis: First, the liabilityto non-union of the gutfrom the absence of peri-toneal investment; and,seco
. Surgery, its principles and practice . and transform-ing this deficient anus, bytwisting the bowel onehalf-turn or more beforestitching, to make a spiralend to the outlet in hopesof its being more manage-able. This addition hasiDeen generally abandonedas giving an improvementin but a small number ofcases, and adding a riskof infection and of gan-grene of the end. The ideal to be at-tained is restoration ofthe canal without tension,and with a continuedsphincteric anus. Tworeasons often preventthis: First, the liabilityto non-union of the gutfrom the absence of peri-toneal investment; and,second, the tension whichleads to gangrene, or atleast tearing of thestitches through the fri-able tissue. A long-enduring fecalfistula often results there-fore, which, however,generally closes in timeand leaves a continentrectum. The conviction hasgradually forced itself up-on the surgical world thatthe sacral method, whileusually more thoroughthan any other, for mid-rectal or high cancer, isinadequate to permit ex-tirpation of the lymph-. FiG. 109.—Abdominal Route for Cancer of the , Divided ends of the sigmoid inverted by purse-stringsuture. Dotted line shows section of the pelvic , Second step. Rectum dissected from the pelvis afterligation of the rnesorectum. c. Third step. Rectum readyfor removal. Kraske method not usually necessary, as theamputation above the anal portion can be done fromabove. This affords excellent drainage. TUMORS OF THE RECTUM AND ANUS. 165 nodes in the sacral hollow, with satisfaction. Hence surgeons bynecessity have lately turned to the abdominal route as giving accessto the rectum and the sacral lymph-nodes, and, as if by generalconsent, the deficiency of the sacral and lower routes has caused a wideacceptance of the abdominal or the combined method as preferable forcancer of the middle or upper rectum. Kraske himself has become its most ardent advocate. The alluringexhibition of the basin of the pelvis fro
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