. Rectal and anal surgery : with description of the secret methods of the itinerant specialists. ngoperation has been decided upon, the bowels should beemptied by laxatives or enemata, and the parts thoroughlycleansed and shaved. If an internal orifice exists, it issimply necessary to pass a director through this into thebowel, and bring the end out through the anus, after whichthe tissue upon the instrument is divided hj a curved bis- ABSCESS AND SINUS: FISTULA I.\ ANO. 63 tourv. Lateral sinuses ami diverticula sliouJil now he laidfi-eely open, where they do nut extend tuo far imni the anus,a
. Rectal and anal surgery : with description of the secret methods of the itinerant specialists. ngoperation has been decided upon, the bowels should beemptied by laxatives or enemata, and the parts thoroughlycleansed and shaved. If an internal orifice exists, it issimply necessary to pass a director through this into thebowel, and bring the end out through the anus, after whichthe tissue upon the instrument is divided hj a curved bis- ABSCESS AND SINUS: FISTULA I.\ ANO. 63 tourv. Lateral sinuses ami diverticula sliouJil now he laidfi-eely open, where they do nut extend tuo far imni the anus,and the wound jiacked with iodoform gauze or lint, coveredwith antiseptic cerate. Vessels of much size should be liga-tured. As a rule there is but little liRnioirhaire. Thosedeep sinuses, which sometimes extend to far distant parts,as into the thigh or buttocks, cannot, of course, be laid openin their entire length. These will heal, however, after thedivision of the sphincter and the lajing open of the princijialsack or fistulous tract. Fistulit which have no internal opening, or in which it. Fig. 29.— Royal Bistoubt with which Chief Suboeon Felix cubedLouis XIV. [Esmarch.] is supposed to exist, if at all, high up in the bowel, are to betreated by division of the lower inch of the rectum point of the director in these cases must be thrustthrough the wall of rectum at a point not much over an inchfrom its external orifice, and the incision made as beforedirected when the internal opening already existed. Thesurgeon may rest confident that that part of the sinus abovethis limit will rapidly close after the division of the partsbelow, and at the same time be free from anxiety about cut-ting the peritoneum, which, in intlamed and prolapsedconditions of the rectum, may be tightly glued to the wallof the gut anil brought somewhat nearer than normal to theanal orifice. In blind internal fistula the reverse procedvire 64 RECTAL AND ANAL SURGERY. is recommended, except that n
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