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A. T. Custer, M.D.
JAMA. 1923;81(7):548. doi:10.1001/jama.1923.26510070002010c.
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Much improvement in the technic of rectal surgery has been made in the last five years, although there has been little improvement in the method of operating in fissure and fistula.

Having been frequently placed in a position of responsibility for a possible incontinence from operation for repair following unsuccessful primary operation, I have devised a method which I have not seen reported and which may prove of interest.

The technic is that usually accepted for fistula operation up to the point of severance of the sphincter muscles. In other words, all tissue is severed on a grooved director until the sphincters appear in sight. All tissue is dissected away from sphincters, the fistulous tract is curetted and carefully cleaned out, and the wound is packed in the usual manner, leaving the sphincter muscles intact at the site of operation. Opposite the site of operation or at the point of


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