rectal instruments

Operation for narrowing of the sphincter with silver wire


By • Дек 26th, 2010 • Category: Rectum

For this operation a curved handled needle with an eye at its point is used. Under general anesthesia and with the patient in the prone Depage’s position (see Figures 25.1 and 25.2) the surgeon introduces the fore finger with its palmar surface facing the coccyx, into the rectum previously washed out. Just lateral to the coccygeal base the surgeon pierces the skin with the unthreaded needle held in his right hand and makes the needle emerge in the rectal lumen. The needle point is then cautiously brougth to the outside through the anus along the surgeon’s finger thrust into the rectum and is threaded with a stout silk ligature (Fig. 113.1).

Next, the threaded needle is again brought out through the skin. After it is unthreaded, the needle is made to appear again in the rectal lumen after piercing the skin, this time from the opposite side of the coccyx; the other end of the ligature is now threaded (Fig. 113.2) and the needle is again brought to the outside. The both ends of ligature thus brought out are then tied tightly over the skin on a gauze roll (Fig. 113.3) or a rubber tube wrapped with gauze. The knot with the roll is pasted with gauze soaked in collodium.

After a period of 15 to 20 days the thread is cut. off on one side immediately over the skin and the entire li­gature is removed.

In rectal mucosa prolapses we generally employ a simple operation for ligation and excision of rebundant mucosa as it is done in hemorrhoidectomy (see Figures 102.1 and 102.2).

Fig. 113 Operation for fixation of the rectum through the skin to the coccyx with silk ligature by Ekegorn's method': 1. Reverdin's needle has been passed through the skin into the rectal lumen and brought to the outside via the anal orifice to be threaded with a long silk ligature. 2. Reverdin's needle has been passed into the rectum for a second time from the opposite side of the coccyx, and is theraded with the other end of the same ligature, 3. The both ends of the ligature have been brought out and tied up tightly on a gauze roll over the skin.

Fig. 113 Operation for fixation of the rectum through the skin to the coccyx with silk ligature by Ekegorn’s method:

1. Reverdin’s needle has been passed through the skin into the rectal lumen and brought to the outside via the anal orifice to be threaded with a long silk ligature.

2. Reverdin’s needle has been passed into the rectum for a second time from the opposite side of the coccyx, and is theraded with the other end of the same ligature,

3. The both ends of the ligature have been brought out and tied up tightly on a gauze roll over the skin.



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