=Operation.= The patient is placed in the Trendelenburg position, and
the abdomen is opened as for ovariotomy, except that the incision is
shorter; the operator then determines with his fingers the position and
condition of the body of the uterus. If it be free, it is then
straightened, and the condition of the ovaries and the tubes
ascertained.
In many patients, where retroflexion of the uterus is accompanied by
pain, the distress is often due to a prolapsed ovary, incarcerated in
the pelvis by the retroflexed fundus of the uterus; in another set of
cases the retroflexion is produced by a tumour in the ovary, such as a
small dermoid, but more often the body of the uterus is drawn backwards
by a small fibroid in the fundus of the organ. In these conditions an
operation embarked upon as a simple hysteropexy may become an
oöphorectomy, an ovariotomy, or a myomectomy, according to the necessity
of the case. When the enlargement of the ovaries is due to œdema from
incarceration, they should be left, as the swelling will quickly subside
when the misplacement of the uterus is corrected.
The uterus is fixed to the abdominal wall in the following way:--
A curved needle armed with a silk thread (No. 4) which has been
carefully boiled is passed through the aponeurosis and adjacent
peritoneum on one edge of the wound, then through the anterior surface
of the uterus near the fundus, and finally through the peritoneum and
aponeurosis on the opposite edge of the incision; when this suture is
tightened, it will be found to draw the uterus to the anterior
abdominal wall, and at the same time approximate the edges of the wound.
Two sutures should be introduced. In patients who have had children care
should be taken not to pass the needle so deeply into the uterus that
the suture traverses the superficial parts of the endometrium and
becomes infected: this will lead to a suture sinus. The rest of the
wound is then closed according to the method described on p. 9.
VENTRO-FIXATION FOR PROLAPSE OF THE UTERUS
=Operation.= When hysteropexy is needed for a large, bulky, and
prolapsed uterus, the steps of the operation are the same as for
retroflexion, but it is necessary to introduce a greater number of
retaining sutures. Further, as the uterus tends to slip downward into
the vagina, it is an advantage, as soon as the fundus of the uterus is
drawn into the wound, to transfix it with a stout suture, in order that
the assistant may use it as a tether to keep the uterus in position
whilst the surgeon introduces the main sutures. In some cases, where the
uterus is very large, it may be requisite to employ four, five, or even
six sutures to secure it to the abdominal wall.
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