Gynaecology for students and practitioners . ligaments, and to furnishthem with fresh attachments. In the intraperitoneal operations, thepart of the round ligament made use of for suspending the uterus is theproximal two or three inches ; this is much stronger than the distalpart which is made use of in the Alexander-Adams operation. Thefresh attachments are usually made to the anterior abdominal wall,but in one method a loop of round ligament on each side is passedbackwards through an aperture made in the mesosalpinx, and thetwo loops are then stitched together and to the posterior uterine wa
Gynaecology for students and practitioners . ligaments, and to furnishthem with fresh attachments. In the intraperitoneal operations, thepart of the round ligament made use of for suspending the uterus is theproximal two or three inches ; this is much stronger than the distalpart which is made use of in the Alexander-Adams operation. Thefresh attachments are usually made to the anterior abdominal wall,but in one method a loop of round ligament on each side is passedbackwards through an aperture made in the mesosalpinx, and thetwo loops are then stitched together and to the posterior uterine the results of this procedure are unsatisfactory, it will not be furtherdescribed. The usual method is to pull a loop of each round ligament-throiigh the deep layers of the abdominal parietes, and stitch them to VENTRISUSPENSION AND VENTRIFIXATION 771 the edges of a small opening made in the anterior sheath of the rectus y /? Fig. 440. The Transverse Abdominal muscle. The procedure can be carried out by different. Fig. 441. A Loop has been passed under the Round Ligament andUSED to pull the Uterus up into the Wound. methods, but that introduced by Gilliam is the best, and this alone 772 GYNECOLOGY will be fully described. The idea underlying GiUiams operation isthat the loop of round ligament should be embedded, as far as possible,in the subperitoneal cellular tissue, instead of being carried acrossthe peritoneal cavity to the parietes. Gilliams Operation. The operation here described, while it followsthe general lines of GUliam, comprises one or two small modificationswhich the authors have found serviceable. The abdominal incision should be transverse, running from thesemilunar line on one side to that on the other, at a level of about twofingers breadth above the symphysis {see Fig. 440). Skin, sub-
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectgynecology, bookyear1
