. Diseases of the rectum and anus: designed for students and practitioners of medicine. h theanus by the index finger of the left hand inserted into therectum for that purpose. Then with a strong bistoury, eitherstraight or curved, the entire bridge of tissue resting uponthe director is divided. This should be done as nearly at a 258 TREATMENT OF ANO-RECTAL FISTULA right angle (Fig. 75) to the sphincter as possible, and not inan oblique direction or zigzag fashion (Fig. 76) as some op-erators do, for incontinence is apt to follow the latter. Afterthe bridge of tissue has been divided, the oppo
. Diseases of the rectum and anus: designed for students and practitioners of medicine. h theanus by the index finger of the left hand inserted into therectum for that purpose. Then with a strong bistoury, eitherstraight or curved, the entire bridge of tissue resting uponthe director is divided. This should be done as nearly at a 258 TREATMENT OF ANO-RECTAL FISTULA right angle (Fig. 75) to the sphincter as possible, and not inan oblique direction or zigzag fashion (Fig. 76) as some op-erators do, for incontinence is apt to follow the latter. Afterthe bridge of tissue has been divided, the opposite wall of thetract is incised, this incision being known as Salmons back-cut. The entire sinus must now be excised or curetted, bleedingvessels ligated, and undermined or irregular pieces of skin cutaway. The wound is then packed tightly with sterile or antisepticgauze, over which a piece of absorbent cotton is placed; thesedressings are secured in position by a strong, well-adjustedT-bandage or the authors operating harness. When the external opening is not of sufficient size to. Fig. 77.—Authors Sets of Graduated Probes and Grooved Directors. admit a probe or director, it should be enlarged by a shortincision made transversely to the main sinus. In cases wherethe internal opening cannot be located and in those where thesinus extends so close to the rectum that the end of the in-strument can be felt from within, the director should be forcedthrough the bowel-wall and the operation completed as de-scribed. Branch-sinuses should be operated upon by passing thedirector from one external opening to the other and dividingthe tissues until all are made to communicate with each otherand the main sinus. Or the main sinus may be divided first,when, by careful sponging, the diverticula will be seen openinginto it at points marked by small masses of dark granulations, TREATMENT OF ANORECTAL FISTULA 259 and they may then be divided. In other cases where thefistulous tract is tortuous
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectanusdis, bookyear1910
