Preparatory and after treatment in operative cases . eration. Thisinterferes with healing, and while the sloughs are separating, theintestine should be kept from coining in contact with the woundsurfaces in the manner stated. Repair of the vaginal vault doesnot, at times, occur until weeks after the operation. If the repairis permitted to go on without guidance, a loop of small intestinepartially prolapses into the space at the vault of the vagina insome instances, and becomes adherent in this situation. Thewriter has seen cases of this sort, and in each instance celiotomyand suprapubic repair
Preparatory and after treatment in operative cases . eration. Thisinterferes with healing, and while the sloughs are separating, theintestine should be kept from coining in contact with the woundsurfaces in the manner stated. Repair of the vaginal vault doesnot, at times, occur until weeks after the operation. If the repairis permitted to go on without guidance, a loop of small intestinepartially prolapses into the space at the vault of the vagina insome instances, and becomes adherent in this situation. Thewriter has seen cases of this sort, and in each instance celiotomyand suprapubic repair of the vaginal vault was made after theintestine has been loosened. The latter step was regarded asdangerous when attempted from the vagina. The ultimate repair 536 GYNECOLOGICAL OPERATIONS BY PERINEAL ROUTE contemplates repair of the vaginal vault with the rectum andbladder forming the dome above the vaginal scar. With this inview, the parts should be manipulated at each dressing, makingsmaller and smaller the tamponade until healing is Fig. 335.—Appearance of Vaginal Vault after Vaginal Hysterectomy. Vaultof Vagina Held in Place with Stitch. (Kelly.) At times a stitch is taken in the center of the vaginal vaultholding together the peritoneum (Fig. 335). This obviates, toa certain extent, the contingency related above, holding awayfrom the vagina] vault the small intestine. In these instances the VAGINAL HYSTERECTOMY 537 packing is introduced on either side of the stitch, and the rest ofthe local after-treatment executed in the manner stated above. During the after-treatment, douching of the vagina is per-missible, but should be performed when the patient is on thetable, as described, and the cleansing made through a speculumto avoid the carrying of infection into the peritoneum. At timesshreds of sloughing tissue may be removed with the dressingforceps. On the whole, the after care following vaginal hysterec-tomy is attended with considerable labor, and should b
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