. Diseases of the rectum and anus: designed for students and practitioners of medicine. opened in both the vaginal andsacral operations, and in neither is it a source of great danger. 4. The diseased tissue is more accessible for inspection, andthe extent to which an operation may be carried in an upwarddirection is as great, if not greater, than by the sacral route. 5. The peritoneum may be drained freely through thevagina. 6. A perfect end-to-end approximation, either by suture » These operations were all performed before January, 1905. Since then he has performedother operations of the same
. Diseases of the rectum and anus: designed for students and practitioners of medicine. opened in both the vaginal andsacral operations, and in neither is it a source of great danger. 4. The diseased tissue is more accessible for inspection, andthe extent to which an operation may be carried in an upwarddirection is as great, if not greater, than by the sacral route. 5. The peritoneum may be drained freely through thevagina. 6. A perfect end-to-end approximation, either by suture » These operations were all performed before January, 1905. Since then he has performedother operations of the same kind. 568 DISEASES OF THE RECTUM AND ANUS or by the use of the button, may be secured. The preferablemethod of uniting the two ends is by interrupted sutures ofsilk; as there is no peritoneum on the sphincteric segment, thedanger of failure of union with the button is present. 7. The sphincter is retained and the perineal body is re-stored. There is diminished action of the levator ani muscles. 8. When the operation is complete the parts are prac-tically in their normal Fig. 183.—Rectal Excision by the Vaginal Route. When feasible, malignant neoplasms located in the upperrectum and sigmoid should be invariably removed through anabdominal incision rather than by superior, inferior, or vaginalproctectomy; because in this procedure less time is required,complications are fewer, the permanent results are just as good,and there is much less danger of shock, hemorrhage, perito-nitis, sloughing of the bowel, and fecal fistula following the TREATMENT OF MALIGNANT TUMORS 569 operation. Again, if the growth is removed through the ab-domen, there is no mutilation of the ligaments, muscles, andbones which support the pelvis; and last, but not least, thesphincter-muscle is preserved, and the patient does not sufferfrom fecal incontinence, but, on the contrary, has perfect con-trol of his stools, which are voided through the natural chan-nel instead of a sacral anus. In those
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