American practice of surgery; a complete system of the science and art of surgery (1906) (14740662816)

Identifier: americanpractic07brya (find matches)

Title: American practice of surgery ; a complete system of the science and art of surgery

Year: 1906 (1900s)

Authors: Bryant, Joseph D. (Joseph Decatur), 1845-1914, ed Buck, Albert H. (Albert Henry), 1842-1922

Subjects: Surgery

Publisher: New York, W. Wood and company

Contributing Library: Columbia University Libraries

Digitizing Sponsor: Open Knowledge Commons

Text Appearing Before Image:

fining thebowels for four or five successive days. It has also been recommended to doa temporary inguinal colostomy for this purpose as well as for protecting thefield of operation from infection. The fistulous tract should be frequentlyirrigated for several days prior to the operation. Until recently failure has attended most of the attempts which have been SURGICAL DISEASES OF THE ANUS AND RECTUM. 831 made to effect a permanent closure of these fistulae. Tuttle, in his work onDiseases of the Anus, Rectum, and Pelvic Colon ()). 484), has pointed outthe chief cause of such failures, and at the same; time ho recommends measuresfor overcoming the defects of the treatment hitherto employed. The successof these measures is evidenced by the reports of nine successive cases in whichthey were employed. We give here in full his modification of the operationfor the correction of urethro-rectal fistula (op. cit., p. 435): The rectum should be incised in the middle line anteriorly, the cut being

Text Appearing After Image:

Fig. 335.—The Drawins Ilhistrates Tuttles Operation for Recto-Urethral Fistula; First Stage.(Tuttle.) carried through into the urethra and extended from the scrotal juncture ofthe perineum into the fistulous opening, thus dividing the urethral stricture.(Fig. 335.) The cicatricial tissue around the entire fistula should be trimmedaway with scissors. The intestinal wall should then be dissected from itsanterior attachments for a distance of three-quarters of an inch above thefistula, and half an inch to each side. A flap, large enough to replace that por-tion of the floor of this organ which had been destroyed, is next dissected fromthe soft tissues on either side of the urethra. A steel sound (No. 30 French) 832 AMERICAN PRACTICE OF SURGERY. is now introduced into the bladder, and these flaps arc sutured together overit at a sUght tension. Secondary flaps are then taken outside of the first flapsand (nitirely surrounding them, making a sort of cuff to the first area sutured.(Fig. 33

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1906

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