Operative gynecology : . ansfixing the rectocele(see Fig. 177). An additional silkworm gut su-ture may sometimes be necessary onthe skin surface extending throughto the bottom of the wound. Half-deep and superficial sutures willcomplete the union. When there is much relaxation,it adds to the efficiency of the opera-tion to bare the levator ani musclein each sulcus and include it in thedeep inside silkworm gut sutures, asrecommended by Dr. C. P. Noble. The duration of the operationis from fifteen to thirty outlining takes about one min-ute and a half, the denudation threeor four min
Operative gynecology : . ansfixing the rectocele(see Fig. 177). An additional silkworm gut su-ture may sometimes be necessary onthe skin surface extending throughto the bottom of the wound. Half-deep and superficial sutures willcomplete the union. When there is much relaxation,it adds to the efficiency of the opera-tion to bare the levator ani musclein each sulcus and include it in thedeep inside silkworm gut sutures, asrecommended by Dr. C. P. Noble. The duration of the operationis from fifteen to thirty outlining takes about one min-ute and a half, the denudation threeor four minutes, and passing the sutures ten minutes longer; various minormatters may lengthen the time to half an hour. The result of the operation is now evident in the change in the position, size,and direction of the vaginal outlet. It has been lifted and restored to its posi-tion well beneath the pubic arch. Its size has been reduced from 5 or 6 to 1|or 2 cm. (f to 2|- inches) in diameter. The examining finger no longer enters. :. 177.—Relaxed Vaginal Outlet. The inside sutures are now introduced and tied inboth sulci. The gathering suture of silkworm gut isintroduced above across the angles, but is not auxiliary suture introduced to close the woundbelow this is also left untied. OPERATION FOR RELAXED VAGINAL OUTLET. 303 in the direction of the promontory of the sacrum, but goes backward towardthe coccyx. This change in direction and position of the outlet removesit from the line of intra-abdominal pressure in which it has lain. Instead,therefore, of the constant tendency to eversion of the vaginal wall through a
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectgynecology, bookyear1
