Gynecology . s held forward out of the wound, sutures are now placed asin Fig. 306, connecting the upper end of the vaginal wound with the fundus ofthe uterus. In attaching these sutures one must keep in mind that it is im-portant to superimpose the entire bladder on the uterus, but not to fix the uterusso firmly against the urethra as to interfere with urination. The vaginal wound is now closed over the anterior surface of the uterus by a OPERATIONS FOR UTERINE MALPOSITION 605 continuous catgut suture, which occasionally catches the peritoneum of theuterus. The transverse incision may be sewe
Gynecology . s held forward out of the wound, sutures are now placed asin Fig. 306, connecting the upper end of the vaginal wound with the fundus ofthe uterus. In attaching these sutures one must keep in mind that it is im-portant to superimpose the entire bladder on the uterus, but not to fix the uterusso firmly against the urethra as to interfere with urination. The vaginal wound is now closed over the anterior surface of the uterus by a OPERATIONS FOR UTERINE MALPOSITION 605 continuous catgut suture, which occasionally catches the peritoneum of theuterus. The transverse incision may be sewed up transversely or longitudinally. If the operation is done during the reproductive period, the uterine ends ofthe tubes should be ligated and severed, and peritoneum sewed over the exposedsurfaces in order to prevent possible impregnation. If the cervix is much elongated and hypertrophied, the operation should bepreceded by amputation of the cervix. In all cases a careful perineoplasty should be H&Kvxjes- Fig. 309. -Watkins Operation for of wound. Wertheim described an operation in 1899 similar to that of Watkins andbased on the same mechanical principles. In the Wertheim operation thebladder is stitched to the posterior wall of the uterus at the level of the internalos (Fig. 310). In closing the vaginal wound a portion of anterior wall of theuterus is left exposed in the vagina (Fig. 311). From a surgical standpoint,Watkins technic is obviously supericr. 606 GYNECOLOGY GOFFES OPERATION FOR PROLAPSE A vaginal operation for moderate prolapse and cystocele somewhat similarin mechanical principle to that of Watkins, though not as radical, has beendevised by Goffe. The uterovesical pouch is opened as in the Watkins operation,or as described for Anterior Colpotomy (see page 576).
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