Le Fort’s operation is an ingenious method of attaining this object. The uterus should be replaced, and a longitudinal strip of tissue, about one-half to one inch in breadth and two to two and a half inches in length, should be denuded on the anterior vaginal wall, extending from a point near the vulva, where the two vaginal walls are in contact when the uterus is in place, up toward the cervix. A similar strip should be denuded on the posterior wall. These two denuded areas should be brought into apposition by interrupted sutures passed transversely. Perineorrhaphy should also be performed. In those cases in which the vagina and the vaginal outlet have become very much stretched by the protruding mass of prolapsed structures, Emmet’s operation seems to be insufficient. In such cases the following operation is useful. This consists in denuding a triangular area on the posterior vaginal wall (Fig. 77), the apex of the denudation being immediately below the cervix, and the base at the ostium vaginæ. The denudation should extend well on to the lateral vaginal walls. The denuded area is then closed by sutures passed transversely. [Illustration: FIG. 71.--Prolapse of the vagina and of the infra-vaginal cervix. The sound showed the internal uterine length to be 5½ inches. An erosion appears on the posterior margin of the os uteri.] Judgment, derived from experience, is necessary in choosing and performing the various plastic operations for prolapse of the uterus. In every case of prolapse a certain degree of retroversion of the uterus is present. In fact, the uterus could not escape from the vagina unless the fundus were turned somewhat backward. The operation of ventro-fixation of the uterus is therefore a useful adjunct in some cases of uterine prolapse. The operation is not intended to furnish a mechanical support to the uterus, but only to keep it in a position of anteversion, so that it will less readily escape through the vaginal canal. The plastic operations and the ventro-suspension may all be done at the same sitting. [Illustration: FIG. 72.--Amputation of the hypertrophied cervix: _A._ The cervix has been split laterally. _B._ The posterior lip is being amputated.] [Illustration: FIG. 73.--The posterior lip has been amputated.] [Illustration: FIG. 74.--_A._ Both lips have been amputated and the sutures have been introduced. _B._ The sutures have been secured by the perforated shot.] [Illustration: FIG. 75.--_A._ The anterior vaginal wall is pushed backward by the staff, while on each side of the median line portions of mucous membrane are grasped by tenacula and brought together in order to determine the position of the strips to be denuded. _B._ Denudation on the anterior vaginal wall (Sims’ operation).]