. Gynecology : . f the uterovesical flap of perito-neum (Fig. 382), except that in this case the bladder is dissected away fromthe vagina for a considerable distance. The peritoneal fold is then carried farover the stump of the cervix and attached low down toward the pouch of Douglasto the posterior wall of the vagina. In this way the cervix and broad ligamentare, in a sense, interposed under the bladder. 698 GYNECOLOGY When this step has been completed, the two silk suspensory sutures arepassed into the abdominal wall, one on each side of the median incision. Eachsuture includes the peritoneu
. Gynecology : . f the uterovesical flap of perito-neum (Fig. 382), except that in this case the bladder is dissected away fromthe vagina for a considerable distance. The peritoneal fold is then carried farover the stump of the cervix and attached low down toward the pouch of Douglasto the posterior wall of the vagina. In this way the cervix and broad ligamentare, in a sense, interposed under the bladder. 698 GYNECOLOGY When this step has been completed, the two silk suspensory sutures arepassed into the abdominal wall, one on each side of the median incision. Eachsuture includes the peritoneum, muscle, and fascia. The knots are tied on theinside as tightly as possible, in order to insure a strong artificial suspensoryligament. The portion of the bladder lying between these two sutures is notcompressed and suffers no later inconvenience. By this operation the supportof the bladder and vagina has a double defense. The primary defense consists / W\\libber _, / I CW^ulftteb teroot—J—| VlCLQVTWJu, _ !. NM.^.G^t^ve,©, Fig. 356.—Operation for Procidentia (Authors Method).Sagittal section showing completed operation. The cervix and body of the uterus have beenamputated, leaving only a disk of uterine tissue. The bladder has been drawn up over this disk andattached by its flap to the posterior wall of the vagina. The whole mass, including the disk, the at-tached broad ligament, and the upper wall of the bladder, has been fixed to the anterior abdominalwall. The manner in which the cystocele is reduced by this maneuver is shown in the drawing. Theauxiliary operation on the anterior and posterior walls of the vagina is not represented. of the two artificial ligaments made between the stump of the cervix and theanterior abdominal wall. The secondary defense consists of the broad liga-ments brought together by their attachment to the cervical stump, on which aportion of the bladder rests as on a shelf. The results of this operation are excellent, there being little dange
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