. Chirurgie du dispositif. un ex-incision externe comme dans oesophagotomy. (Esopliagotoniy internes (division interne).-resophagotomyconsists interne à la division des tissus de constriction à la manière des ure-thral pratique, avec grande structure de l'instruments utilisés en à-urethrotomy interne (Fig. 852, h). Un instrument disposées de manière à bepassed sur un guide, comme dans urethrotomy interne, a bien été em-tion à plusieurs reprises dans oesophagotomy interne. Cependant, la con-tiguity important de structures anatomiques, et l'impossibilité d'comprehendthe relations exactes de la str

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. Operative surgery. an ex-ternal incision as in oesophagotomy. Internal (Esopliagotoniy (Internal division).—Internal resophagotomyconsists in the division of the constricting tissue after the manner of ure-thral practice, with enlarged patterns of the instruments employed in in-ternal urethrotomy (Fig. 852, h). An instrument arranged so as to bepassed upon a guide, as in internal urethrotomy, has been successfully em-ployed on several occasions in internal oesophagotomy. However, the con-tiguity of important anatomical structures, and the inability to comprehendthe exact relations of the stricture to the outer wall of the tube, make theoperation an exceedingly hazardous one. If it be attempted, the constric-tion should be incised only sufficiently to admit a bougie, by means of whichdilatation should be subsequently practiced. OPERATIONS ON THE CESOPHAGUS. 6Y5 The Results.—In nineteen cases of internal cesophagotomy treated byincision, one third died in sixteen davs from results associated with the. Fig. 853.—Abbes string friction method; string escaping through a low cervicalcesophagotomy instead of through the mouth. operation. Of the remainder, three are said to have recovered, while theothers survived for a period from one month to several years. xA.bout onethird of the cases required one or more repetitions ofthe operation. The division of the stricture hy means of stringfriction, as devised by x4.bbe and practiced by him-self and others, is a decided advance along the lineof safety in the treatment of stricture of the oesopha-gus. The stomach is opened sufficiently to admit twofingers, along which as a guide, a bougie carrying along silk thread is passed up the oesophagus and outof the mouth (Fig. 853). The lower end of the stringis seized and the stricture made tense by the introduc-tion of a conical bougie (Fig. 85i); after which theupper end of the string is grasped and carried wellback into the pharynx, while the lower end is carriedinto the stomac

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