. Gynecology : . partly because it will not break in tying theknot and partly because it will not cut into the tissues when powerful tensionis put upon it. It is somewhat undesirable to bury such a large permanentligature in the abdominal wall, for if there is wound sepsis it may possibly be-come infected and cause a persistent sinus until it is removed. This does happenonce in awhile, but the occurrence is so rare that it does not offset the advantagesof the ligature. It may be said in passing that a far more powerful and lasting ligament can be createdbetween the round ligament and the abdom
. Gynecology : . partly because it will not break in tying theknot and partly because it will not cut into the tissues when powerful tensionis put upon it. It is somewhat undesirable to bury such a large permanentligature in the abdominal wall, for if there is wound sepsis it may possibly be-come infected and cause a persistent sinus until it is removed. This does happenonce in awhile, but the occurrence is so rare that it does not offset the advantagesof the ligature. It may be said in passing that a far more powerful and lasting ligament can be createdbetween the round ligament and the abdominal than between the uterine wall and the abdomi-nal wall. Fixation of the round ligaments is, therefore, more reliable than fixation of the uterusboth for supporting strength and for the avoidance of immobilizing adhesions. The Olshausen operation has the disadvantage of leaving two open spacesbetween the ligaments and the abdominal wall external to the stitches (). ^ovixCb^vdaxxveuXs 4~£ ? S*- (fat*. ^.xxXweum Fig. 334.—Gilliams Operation. The red lines indicate the course of the round ligaments, which are drawn up through all the layers and fastened on the outside of the fascia. VARIOUS FORMS OF THE GILLIAM OPERATION Gilliams Operation.—By the technic of the original Gilliam operation theperforating clamp is carried directly through the fascia, muscle, and peritoneum OPERATIONS FOR UTERINE MALPOSITION 681 into the peritoneal cavity without taking the oblique route through the internalring. The round ligament is drawn directly out through the perforation andfastened to the outer side of the fascia (Fig. 334). This has the advantage overSimpsons -operation of providing a direct rather than an indirect pull on the
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