Gynecology . may be incised later. OPERATIONS ON THE VAGINA 575 introitus. The outer wall of the gut is incised and the edges stitched to theskin around the hymeneal opening. The two legs of the loop are twisted so thatthe left lies anterior and the right posterior. In this way a double vagina isformed (Fig. 273). The walls of the gut which form the septum between thetwo vaginal canals become adherent in the course of time. This septum maybe incised later, so that a simple vagina is created. It should be rememberedthat the mucous membrane of the new vagina continues to secrete, and that itcons
Gynecology . may be incised later. OPERATIONS ON THE VAGINA 575 introitus. The outer wall of the gut is incised and the edges stitched to theskin around the hymeneal opening. The two legs of the loop are twisted so thatthe left lies anterior and the right posterior. In this way a double vagina isformed (Fig. 273). The walls of the gut which form the septum between thetwo vaginal canals become adherent in the course of time. This septum maybe incised later, so that a simple vagina is created. It should be rememberedthat the mucous membrane of the new vagina continues to secrete, and that itconstitutes an absorbing surface, to which certain kinds of vaginal douches,like corrosive sublimate, may be a dangerous poison. The secretion is influencedby diet, being greatly increased by albuminous food. VAGINAL CELIOTOMYAnterior and Posterior Colpotomy The vaginal route for the surgical treatment of such conditions as uterinefibroids, ovarian tumors, pelvic adhesions, extra-uterine pregnancy, etc., is now 1. Fig. 275.—Anterior Colpotomy for Pelvic Operations by the Vaginal Route. comparatively little used, and is for the most part confined to operations forprolapse, like those of Watkins and Goffe, and occasionally to vaginal hysterec-tomies. 576 GYNECOLOGY The pelvis may be entered either by opening the anterior or posterior wallof the vagina. Anterior colpotomy is performed in the following way: The anterior lip ofthe cervix is seized with traction forceps, and the uterus drawn strongly downtoward the introitus. The peritoneal cavity may be entered either through atransverse incision made at the junction of the bladder and cervix or, pre-ferably, by a 1-shaped opening. By the latter method an incision is madefrom a short distance below the urethra to the cervix. The vaginal wall oneach side is then loosened from the bladder and a cross incision made at right
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