. A manual of gynæcology and pelvic surgery, for students and practitioners. FiG. 145.—Inguinal shortening of the round ligaments. Both ligaments havebeen stitched to the external oblique aponeurosis. duced more readily in this locality than in any other portion ofthe abdominal wall. The after-treatment is that of a simple laparotomy, butespecial care is necessary that the bladder does not become dis-tended and force the uterus posteriorly before healing is 300 OPERATIONS UPON THE UTERUS AND ITS LIGAMENTS complete. A pessary may be introduced at the close of theoperation and allowed to remain
. A manual of gynæcology and pelvic surgery, for students and practitioners. FiG. 145.—Inguinal shortening of the round ligaments. Both ligaments havebeen stitched to the external oblique aponeurosis. duced more readily in this locality than in any other portion ofthe abdominal wall. The after-treatment is that of a simple laparotomy, butespecial care is necessary that the bladder does not become dis-tended and force the uterus posteriorly before healing is 300 OPERATIONS UPON THE UTERUS AND ITS LIGAMENTS complete. A pessary may be introduced at the close of theoperation and allowed to remain for several weeks to assist inretaining the uterus in its normal position if a plastic operationhas not been performed at the same Fig. 146.—Intra-abdominal shortening of the round lij^aments. The Gilliamoperation. The round ligaments are surrounded by loops of silk to act astractors. Diagrammatic. {Redrawn from Gilliam.) INTRA-ABDOMINAL SHORTENING OF THE UTERINE LIGAMENTS Various methods have been devised for shortening the roundligaments after opening the abdomen, but the two mostgenerally useful are the Gilliam and the Baldy-Webster. THE BALDY-WEBSTER OPERATION 30I The salient points of the Gilliam are as follows: After theabdomen is opened in the mid-line the anterior sheaths of therecti are cleared of fat and a perforation is made on either side,2 cm. external to the margin of the incision. This perforationis 4 cm. above the crest of the pubes and extends through allthe layers of the abdominal wall beneath the superficial fascia
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