A System of Operative Surgery, Volume 4 (of 4) — John Shaqi
A System of Operative Surgery, Volume 4 (of 4)
Science
A System of Operative Surgery, Volume 4 (of 4)
Surgery, Operative
After removing the diseased parts and securing the large vessels
directly concerned in the pedicles, attention is directed to the oozing
from the torn tissues in the floor of the pelvis. Any vessel which is
bleeding should be ligatured with thin silk, and then the recesses of
the pelvis may be firmly plugged with a dab wrung out of hot water: this
is a valuable measure of hæmostasis. This dab is removed in two or three
minutes, and any vessel which is bleeding is quickly seen and ligatured.
In cases where the enucleation of adherent and inflamed tubes leaves
large raw and slightly oozing surfaces in the pelvis, drainage is a wise
precaution. After a trial of a variety of measures for this purpose I
find the simplest to be a narrow rubber drainage tube reaching to the
bottom of the pelvis and emerging at the lower extremity of the
abdominal incision. It is rarely required for more than forty-eight
hours. Some surgeons are opposed to drainage, and one writer compares it
to ‘defending oneself against the sparks of Vulcan with an umbrella’;
his mortality is high.
In simple cases the incision is closed according to the method
described on p. 9; but after the removal of suppurating ovaries and
tubes it is better to unite the wound by a single layer of sutures
through all the tissues of the abdominal wall: buried sutures in such
conditions nearly always give trouble.
=Abdominal hysterectomy after bilateral oöphorectomy and ovariotomy.=
After the complete removal of the ovaries and tubes the uterus is a
useless organ, and when the ‘appendages’ have been removed for
inflammatory lesions, acute or chronic, it may become a troublesome
organ. In some instances a uterus devoid of its appendages has been
attacked by cancer. In a few instances in which patients have undergone
bilateral oöphorectomy, or bilateral ovariotomy, successful conception
has followed the operation (see p. 17).
The most annoying consequences which follow bilateral oöphorectomy for
salpingitis, acute or chronic, are hæmorrhage, pain, or a purulent
discharge. Every surgeon with an ordinary experience of this class of
surgery has probably had to remove the uterus on several occasions as a
sequel to bilateral oöphorectomy.
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