External oesothagotomy in the operative treatment of cicatricial stricture of the oesophagus : with a proposition for improving the method of performing internal oesophagotomy / by Willy Meyer.

  • Meyer, Willy, 1858-1932.
Date:
[1892]
Catalogue details

Licence: Public Domain Mark

Credit: External oesothagotomy in the operative treatment of cicatricial stricture of the oesophagus : with a proposition for improving the method of performing internal oesophagotomy / by Willy Meyer. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    15/28 (page 13)
    died, but probably be cured to-day; for that only a free division of the contracted long cicatricial tube does really “ cure ” such a stricture which does not yield to stretching, where false passages have been bored by the frequent at- tempts at sounding from the mouth, I am fully satisfied. I would put the radical treatment of these contractions on ex- actly the same basis as that of urethral strictures. Unhappily, the surgery of the posterior mediastinum has not yet advanced so far as to enable us to attack the lower oesophageal stricture as we do the upper ones—from outside. Perhaps surgery will never attempt as much, and, if it would, such an undertaking would perhaps be unwise and impracti- cable. There are no soft tissues around which in cicatrizing with the oesophageal wound would pull its cut surfaces out- ward in the shape of a funnel, as the peringeum does after ex- ternal urethrotomy, thus partially guarding against a recur- rence of the trouble. I therefore believe that rebellious strictures of the oesophagus in its intrathoracic portion must always be divided from the inside, provided they are divided at all. Such a thorough operation, with the help of a deep incision, is here of course accompanied, besides the proba- ble septic infection, as emphasized before, by another great danger—perforation of the oesophageal wall by the knife, with subsequent posterior mediastinitis, pleuritis, or arterial fatal haemorrhage from the aorta or common carotid. The latter accident can partially be avoided by not carrying the incision so deep as to penetrate the oesophageal wall in its entire thickness. It will be a matter of personal tact and judgment to avoid such an accident as much as possible. A number of shallow cuts with subsequent dilatation, if necessary repeated, might in some cases prove of perma- nent benefit.* Still we have a right to presume that a * Yon Bergmann (Ueber Operationen am Schlundrohre, Deutsche med. Wochenschr., 1883, No. 42 ii. 43) wants internal oesophagotomy