Operative gynecology : . nal fistula? when they can not be satis-factorily exposed on the vaginal side; also for fistula? in the immediate neigh-borhood of the ureter, for vesico-uterine, uretero-cervical, and uretero-vaginalfistula?: The patient is placed on the table with the pelvis well elevated at an axisof not less than forty-five degrees to the horizontal; by this posture, when thebladder is incised, it at once fills with air, and its entire interior is well exposedto view. VESICAL FISTULA. 435 The bladder is opened by making a transverse incision 10 cm. long acrossthe upper border of th
Operative gynecology : . nal fistula? when they can not be satis-factorily exposed on the vaginal side; also for fistula? in the immediate neigh-borhood of the ureter, for vesico-uterine, uretero-cervical, and uretero-vaginalfistula?: The patient is placed on the table with the pelvis well elevated at an axisof not less than forty-five degrees to the horizontal; by this posture, when thebladder is incised, it at once fills with air, and its entire interior is well exposedto view. VESICAL FISTULA. 435 The bladder is opened by making a transverse incision 10 cm. long acrossthe upper border of the symphysis, separating the attachments of both rectimuscles, and exposing the prevesical space; a transverse opening in the bladderis then made 5 to 6 cm. long. The edges of the fistula now exposed aredenuded in the form of a shallow funnel in such a way as to remove a broadband of tissue from the bladder mucosa, and a narrow one from the vaginaand cervix. The edges are brought together with silkworm gut sutures; in the. Fig. 261.—Suprapubic Operation for Vesico-vaginal Fistula (Trendelenburg). Sagittal Sec-tion. Suprapubic Incision seen Above. first cases these were the bladder, but later two needles were threadedon one suture, and both ends were passed through into the vagina, where theywere tied. The incision into the bladder is now closed down to an opening left for aT-drain. The patient is compelled to lie in Sims position until the fifth day,when she may turn over for a time on her back. The drainage tube is removedfrom the ninth to the twelfth day, after which the abdominal wound heals ofitself. While the attempt to close a fistula in this way failed in the first two cases,it succeeded in the following two. In the case described in detail by the authorthe fistula was the size of a plum stone, fixed by scar tissue, and associated withthe loss of the right half of the cervix. Dr. H. C. Coes case, cited above, in which the uterus had been amputatedfor a parturien
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectgynecology, bookyear1
