Gynecology . and thepeculiarly disturbing constitutional symptoms which the disintegration of theclots seems to produce. The peritoneum is closed by deep figure-of-8 cat-gut stitches (Fig. 360), this form of stitch being especially valuable bothbecause of its broad approximation of tissues and because by its use fewer knotsare exposed on the surface of the uterus. The enucleation of large intramural myomata is a bloody operation, and MYOMECTOMY OPERATIONS 653 results in great mutilation of the uterine body. It should not be undertakenexcept under extraordinary circumstances. Pedunculated myoma
Gynecology . and thepeculiarly disturbing constitutional symptoms which the disintegration of theclots seems to produce. The peritoneum is closed by deep figure-of-8 cat-gut stitches (Fig. 360), this form of stitch being especially valuable bothbecause of its broad approximation of tissues and because by its use fewer knotsare exposed on the surface of the uterus. The enucleation of large intramural myomata is a bloody operation, and MYOMECTOMY OPERATIONS 653 results in great mutilation of the uterine body. It should not be undertakenexcept under extraordinary circumstances. Pedunculated myomata, on theother hand, even of very large size, may be removed without danger. When it is necessary to remove a considerable number of small myomata itis important when possible to make incisions in the uterine wall in such a waythat more than one tumor may be extracted through the same incision. Thisis advantageous because it makes fewer wounds in the uterine wall along whichpostoperative adhesions may Fig. 360.—Abdominal wound in the uterine wall is being closed with figure-of-8 sutures deeply placed. After a myomectomy operation it is always advisable to suspend the uterusin some appropriate way in order to prevent the possibility of an adherent retro-version, a complication which otherwise is extremely likely to occur. VAGINAL MYOMECTOMY By vaginal myomectomy is meant the removal of pedunculated submucousmyomata through the vagina, and not, as it is used in some books, the enuclea- 654 GYNECOLOGY tion of intramural and subperitoneal tumors by vaginal section, a procedurewhich is not recommended by the present writer.
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