A Text-book of Diseases of WomenPenrose, Charles B. (Charles Bingham)
Science
A Text-book of Diseases of Women
Penrose, Charles B. (Charles Bingham)
Women -- Diseases
The ovary and the tube are drawn into the abdominal incision, and
the pedicle formed by the broad ligament is transfixed with the
pedicle-needle carrying a double ligature.
The loop of the ligature is passed over the tube and ovary and the Tait
knot is tied, or the ligature is cut and each half of the pedicle is
separately secured, the ligature being crossed or linked in the middle
of the stump, to prevent separation.
The operators who apply the ligature in this way do so because they
fear hemorrhage if every portion of the broad ligament is not secured.
This fear is unfounded. The objections to this form of ligature, the
Tait or the link-ligature, may be given by the following quotation from
a former paper by the writer.[4]
“The objections to these ligatures are: The liability to slip; the
difficulty or impossibility in some cases of removing all the ovary and
tube; the fact that the broad ligament is puckered up and made more
tense than normal, and may for this reason cause subsequent pain and
discomfort; an unnecessary amount of tissue is strangulated.
“Most operators have seen cases, either in their own experience or in
the experience of others, in which the ligature has slipped from the
pedicle, either during the operation or some days afterward. I think
that this accident, usually unrecognized, is a very common cause of
death after oöphorectomy. Tait speaks of a certain number of cases in
his own experience in which a hematoma occurred in the broad ligament
some hours or days after operation. He says, ‘I cannot form any exact
estimate of how many cases of these operative hematoceles I have seen,
but it certainly is not less than 50, and is more likely to be 70 or
80.’
“It seems probable that this accident is due to the retraction or
slipping of the artery from the embrace of the ligature, while the
remaining mass of tissue which forms the pedicle is still retained, and
the hemorrhage, therefore, is confined to the broad ligament. I have
seen this accident happen before the abdomen had been closed, and have
sought for and ligated separately the retracted vessel.
“Slipping of the ligature is due to the form of the mass of tissue
which is ligated. The broad ligament is drawn up into a more or less
conical shape, all parts converging toward the ligature, and the
ligature is really placed at the apex of a cone from which it may
readily slip; and the elastic artery, tied when upon the stretch, tends
to retract and escape from the embrace of the ligature.
Public-domain text, read in full here on John Shaqi.
Reviews
Reviews
No reviews yet
Be the first to share your thoughts on this work.
Elsewhere in the archive
Join the Discussion
Join the discussion
Sign in to leave a comment or review.
Sign InorCreate an account