Cesarean section . to be the more logical method, andI can see no disadvantages in it. The one objection to this method of operation which is apparent is,that the opening in the peritoneum is often not large enough to permitthe extraction of the fetal head without tearing, thus opening the generalcavity, and this accident has been reported several times. If this hap- EXTRA- AND TRANSPERITGNEAL- CESAREAN SECTIONS 167 pens, the advantages of this method are largely done away with, sincethe opening into the peritoneal sac permits easy contamination of theperitoneum as a whole. This is to be preve
Cesarean section . to be the more logical method, andI can see no disadvantages in it. The one objection to this method of operation which is apparent is,that the opening in the peritoneum is often not large enough to permitthe extraction of the fetal head without tearing, thus opening the generalcavity, and this accident has been reported several times. If this hap- EXTRA- AND TRANSPERITGNEAL- CESAREAN SECTIONS 167 pens, the advantages of this method are largely done away with, sincethe opening into the peritoneal sac permits easy contamination of theperitoneum as a whole. This is to be prevented by making as large anopening as possible in the peritoneum, and, according to Hirst, suturingthe peritoneal layers, as above described. After the peritoneum is closedthe abdominal wall is closed without drainage. This method of delivery possesses certain very definite advantagesover the true extraperitoneal methods. First and most important is theease with which it can be performed. Any surgeon who is properly. Fig. 44.—Hirsts Operation (I).Abdominal incision. qualified to perform a classical cesarean section can do this operationwhen it seems desirable, a fact which does not hold true of any of thetrue extraperitoneal operations, which are often technically difficultand require special training on the part of the operator. It may properlybe urged that cesarean section should only be performed by thoroughlyqualified surgeons, but the fact must be recognized that there are inmany communities surgeons who are sufficiently trained to perform aclassical cesarean section in emergency, but who are not qualified to per-form a more complicated operation. It is. however, unfortunately truethat in such communities the need of a primary cesarean section is sel-dom recognized and the very type of case in which an extraperitoneal i68 CESAREAN SECTION operation would be indicated in skilled hands is the most common. Thisfact renders the transperitoneal section the operation of choice
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