. Gynecology : . done for only a short distance,for it is impossible to determine the patency of the tube near the uterus evenunder normal conditions, it being too small to admit a fine probe without dangerof injuring the tubal mucous membrane. The question of patency in this partof the tube must, therefore, be guessed at from its general appearance. The tube is then slit up a short distance in order to make the new ostium 762 GYNECOLOGY wider. The mucous membrane of the tube is next united to the peritonealcovering with sutures of No. 00 catgut passed in a very fine needle. It is im-portant t
. Gynecology : . done for only a short distance,for it is impossible to determine the patency of the tube near the uterus evenunder normal conditions, it being too small to admit a fine probe without dangerof injuring the tubal mucous membrane. The question of patency in this partof the tube must, therefore, be guessed at from its general appearance. The tube is then slit up a short distance in order to make the new ostium 762 GYNECOLOGY wider. The mucous membrane of the tube is next united to the peritonealcovering with sutures of No. 00 catgut passed in a very fine needle. It is im-portant to accomplish this with as few stitches as possible, for the catgut knotsare especially liable to promote adhesions. It is usually necessary to use onlythree sutures, as seen in Fig. 422. Another method for performing a stomatoplastic operation on the tube is thatproposed by Bell and illustrated by Fig. 423. This operation is applicablewhere there has been a closure of the fimbriated end without serious damage to. Fig. 423.—Bells Salpingostomy. A longitudinal incision is made in the closed and dilated end of the tube. The perineum and mucous membrane of the tube are united with a hemstitch suture. the tubal wall or closure of its lumen. A long longitudinal incision is made nearthe end of the tube. The edges of the wound are whipped over with a hemstitchof fine catgut. OPERATION FOR TUBAL STERILIZATION It is occasionally important to sterilize a patient without the removal ofany of the organs. Simple tying of the tubes is quite inadequate, as the lumenof the tube becomes readily re-established. The same is true of section of thetube and ligature of the cut ends. Among the numerous methods recom-mended for tubal sterilization we have adopted that of Taussig, who describeshis operation as follows: The abdomen is opened by a small median incision in the usual manner,and the uterine end of one Fallopian tube seized with forceps. The uterus isthus pulled into view, so that a suture
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