Gynecology . seized at itsend with a pair of toothed clamps, by which it can be held in a convenientposition; the dissection is then carried to the end of the fistula. If there areramifications of the fistulous tract, these are also dissected out. As little damageis done to the fibers of the-sphincter muscle as possible, it being unnecessarysometimes to cut them at all. If the fistula has entered the lumen of the bowel the opening is first closedwith fine catgut sutures applied from the wound side. If the sphincter has been 714 GYNECOLOGY injured, fine catgut sutures are placed in such a manne
Gynecology . seized at itsend with a pair of toothed clamps, by which it can be held in a convenientposition; the dissection is then carried to the end of the fistula. If there areramifications of the fistulous tract, these are also dissected out. As little damageis done to the fibers of the-sphincter muscle as possible, it being unnecessarysometimes to cut them at all. If the fistula has entered the lumen of the bowel the opening is first closedwith fine catgut sutures applied from the wound side. If the sphincter has been 714 GYNECOLOGY injured, fine catgut sutures are placed in such a manner as best to unite thelacerated fibers, the figure-of-8 stitch being especially useful in accomplishingthis result. When the dead space left by the removal of the fistula has been,for the most part, closed, a small drain of folded rubber tissue is placed in thebed of the wound and led out through a stab-wound to one side and below thelevel of the operation. The wound is closed with deeply placed silkworm-gut. Fig. 420.—Operation for Fistula in Ano (Authors Method).The fistutous-tnrct has been dissected down to its entrance into the rectal canal. During thedissection the director is kept in to serve as a guide. The fistulous tube made by the dissection iskept taut by a pressure forceps attached to the tissue about the opening. sutures which are shotted. Any inequalities in the approximation of thewound are smoothed over with superficial stitches of fine catgut, a matter ofconsiderable importance for preventing the entrance into the wound of con-taminating organisms. The silkworm-gut stitches are removed on the ninth day, and on the follow-ing day the patients bowels are moved for the first time by oil catharsis andenema. The small drain is removed on the third day. OPERATIONS ON THE RECTUM 715 The results of this operation in the authors hands have been excellent, thepercentage of delayed convalescence and discouraging recurrence being muchless than after the employment of oth
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