. Operative gynecology. rior and posterior semilunar lines of peritoneum which border thewound area in front and behind are now brought together by a continuous cat-gut suture, beginning at the pelvic brim on one side and extending down acrossthe pelvic fioor and up to the brim on the opposite side, where the suture is tied. If the possibility of contamination has been excluded throughout the opera-tion the abdominal incision may now be closed by the three layers of sutures, tothe peritoneum, fascia, and skin; but whenever there has been any contamina- 330 ABDOMINAL HYSTEKECTOMT FOE CARCIKOMA
. Operative gynecology. rior and posterior semilunar lines of peritoneum which border thewound area in front and behind are now brought together by a continuous cat-gut suture, beginning at the pelvic brim on one side and extending down acrossthe pelvic fioor and up to the brim on the opposite side, where the suture is tied. If the possibility of contamination has been excluded throughout the opera-tion the abdominal incision may now be closed by the three layers of sutures, tothe peritoneum, fascia, and skin; but whenever there has been any contamina- 330 ABDOMINAL HYSTEKECTOMT FOE CARCIKOMA OF THE UTERUS. tion from the uterixs or vagina the operation should not be concluded withoutfirst thoroughly washing out the pelvis with normal salt solution with the pa-tient in a horizontal position. A loose gauze pack is now pushed up through the vagina and through theopening at its vault to give support to the peritoneum and to drain the wound;at the same time the vagina should be loosely filled with a similar Fig. 471.—Sagittal Section, showing the Left Side of the Pelvis, with the Opekation Completed. The anterior and posterior peritoneum is united by a continuous catgut suture. Tlie stump containingthe ovarian vessels is seen at tlie pelvic brim, this is usually turned under and concealed ; the sutured peri-toneum above this has been opened in order to dissect out the enlarged iliac glands. The vaginal vault isnot closed, but a gauze pack is placed in the vagina and up under the peritoueum. Shock from the prolonged operation must be sedulously guarded against bykeeping the patient well wrapped in woolens, and with hot-water bottles about herduring its performance, by giving hypodermics of strychnin at suitable intervals,by avoiding all unnecessary delay, so as to make the anesthesia as short as possible,and by giving a hot stimulating rectal enema just before she goes off the table. For anemia and hemorrhage it will be best to infuse from 500 to 800 cubiccentime
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectgenitaldiseasesfemal
