Gynaecology for students and practitioners . ure is desirable for the latterstructure, as it contains a good deal of muscular tissue which retracts,?ind it is usually accompanied by an artery of considerable size, The OPERATIONS ON THE UTERINE ADNEXA 765 fourth ligature shown in Figure 437 is not required unless the pedicleis long or thick. If the uterine end of the tube is much thickenedit should be excised along with a wedge-shaped piece of the uterinecornu, the gap thus left in the uterus being closed with interruptedstitches. This will obviate the risk of subsequent trouble arisingfrom the
Gynaecology for students and practitioners . ure is desirable for the latterstructure, as it contains a good deal of muscular tissue which retracts,?ind it is usually accompanied by an artery of considerable size, The OPERATIONS ON THE UTERINE ADNEXA 765 fourth ligature shown in Figure 437 is not required unless the pedicleis long or thick. If the uterine end of the tube is much thickenedit should be excised along with a wedge-shaped piece of the uterinecornu, the gap thus left in the uterus being closed with interruptedstitches. This will obviate the risk of subsequent trouble arisingfrom the stump of the infected tube. In bilateral suppurative cases, both ovaries are frequently soclosely involved, that their removal is called for as being probable fociof infection. When this is the case it is better to remove the uterusas well, for the following reasons : [a) the organ is functionless whenboth ovaries have been removed ; (h) it is in many cases infected also,and may give rise to much subsequent trouble if not removed ; (c) the. Fig. 437. Ligatukinu the Pedicle in Sections afikr hie Itbe andOvAKY HAVE BEEN CUT AWAY (modified from Kelly and Noble). operation-field can be much more efficiently drained when the uterushas been removed ; {d) the severity and duration of the operation arenot appreciably increased by this procedure. The method of totalhysterectomy has been described on pp. 745-751. The restoration of the peritoneal covering of the pelvic floor is oftena matter of some difficulty after these operations. Usually the perito-neal covering of the bladder can be largely utilized, and raw areasof considerable extent, which cannot be covered, may be shut offfrom the general abdominal cavity by stitching over them a freeloop of the pelvic colon; or a piece of the omentum may be graftedover it. Drainage is always necessary in difficult cases although no absoluterule need be laid down {see p. 738). The vaginal route is the route ofchoice, and when the whole of the u
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectgynecology, bookyear1
