Operative surgery, for students and practitioners . external sphincter care-fully and accurately sutured together. The lower, diseased part ofthe bowel is amputated, and the end of the sigmoid sutured to theedges of the anal margin, all around, with silk sutures placed quiteclose together, spaces of one-half inch between them. A rubber tube wrapped around with gauze is introduced into OPERATIONS UPON THE AXUS AND RECTUM. 573 the rectum to permit the escape of gas, etc. A gauze strip is packedinto the posterior part of the perineal incision, behind the analopening, and reaching well up into the
Operative surgery, for students and practitioners . external sphincter care-fully and accurately sutured together. The lower, diseased part ofthe bowel is amputated, and the end of the sigmoid sutured to theedges of the anal margin, all around, with silk sutures placed quiteclose together, spaces of one-half inch between them. A rubber tube wrapped around with gauze is introduced into OPERATIONS UPON THE AXUS AND RECTUM. 573 the rectum to permit the escape of gas, etc. A gauze strip is packedinto the posterior part of the perineal incision, behind the analopening, and reaching well up into the space between the rectum infront and the sacrum behind, in order to insure good drainage ofthis space. A second drainage strip is inserted into the anteriorpart of the incision, in front of the anus. Vaginal Method.—Access to the rectum may be obtainedthrough an incision in the posterior wall of the vagina. After therectum has been exposed it is detached in the manner described inthe preceding operations,—perineal method. After the rectum has. Fig. 255.—Amputation of the Rectum (Quenu). The rectum has been ampu-tated and the lower edge of the sigmoid sutured to the edges of the anal drains emerge from the incisions in front of and behind the anus. T, arubber tube wrapped around with gauze, which is introduced into the rectumto permit the escape of gas, etc. been resected or amputated the incision in the vaginal wall is closedby suture. Sacral Route (Kraske).—The rectum is approached through anincision in the sacro-coccygeal region after the coccyx and usuallya portion of the sacrum have been removed. This plan of operationis well adapted to resection of a portion of the rectum, where thedisease is limited to the upper part of the rectum and the anal por-tion is healthy. It affords good access to the upper diseased part ofthe bowel. Through this route the diseased portion may be resectedand the upper end of the bowel brought down and sutured to thelower,
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