Restoration of the round ligaments

5’78

THE

AlllERlCAX

.JOT:RNAI,

OF

Ol3P’I’ETRICS

ANU

(~‘Y‘Nk:(:OT~O(:W

once with twins. There were no cases of nuusual discomfort Itming l~rrguaucy, Nine cases were delivered spontaneously. Onr Case each rcqui red operative dcliverJ because of breech, transverse and face prcrent.ation, and one case required forceps delivery because of rigidity of the soft parts. Five cases ab~rrtrld, clue ~vas delivered prematurely at the eighth mouth, while three wcrc rtiil preguaut at the time of the report. In ten cases operated for sterility, conception took place within six months of the operation, though in four cases the sterility had la.sted fram 4 to I.5 years. .\f.\Hli.\fIET s("IT,T.%E.

Nyulasy, Arthur nal,

December

J:

Restoration

9, 1922,

of the Round Ligaments.

Hri I ish 11 c’(I il,:t I .I (ui r

1118.

The author traces the history of devclopruc~ut of operations for support of the retroverted uterus from the timo of Lawson Tait, and bricfiy mentions some of the vari.ous operations for the restoration of the normal position of the uterus. His own operation consists in splitting the anterior leaf of the broad ligament parallel to the round ligament, hetweeu the round ligament aud the bladder, undermining the opening, and closing it by a purse-string, the outer limit of the pursestring being in the vicinity of the internal atldominal ring and the inner limit being towards the uterine horn. The immediate effect is to ltriug the uterus into anteversion, and to demonstrate the round ligameuts contracted down to their normal length-an interesting physiologic experiment performed directly under the, eye. Furthermore, the undue laxity of the anterior leaf of the l~ro:t~\ ligament is seen to be reduced. In over 200 cases this operation has caused uo compliration during subsequent pregnancies and parturitions, and it has 11reu accompanied by uniformly good results. F. LA Aoar1:.

Nutting : fiir

The One-sided Alexander

Geburtshilfe

und

Operation

Gyniikologie,

1926,

and Its End

lxsxiii,

Results.

Xeitschrift

151.

In view of the almost complete disuse into which the Alexander operation has fallen in America, this discussion of the merits of the unilateral operation is rather interesting. The author considers end-results iii a series of cases in which only one ligament was shortened, e.g., because of iuability to find the other, or poor condition of the patient, etc. He reports 12 per cent recurrences in 26 cases followed for sufficient length of time. The operaCon is uot applicatflc ttb cases with large, heavy uterus, or where the ligaments arc markedly thinned, as well as in women subject to hard physical labor or with a teudency to’ abortion. It may be used with good results in other cases of moval~le rrtropositiou mheaJIA~~:~FLET Rent-l.73. ever a prolonged operation is contraindicated.

Bagley : Mealical

A Modification Association,

of the B&My-Webster 1921,

lxxvi,

Operation.

Journal

American

791.

Instead of sewing the round ligaments to the posterior wall of the uterus, Bagley proceeds as follows: A vertical incision from 1 to 1% in. is made on the posterior wall of the uterus, midway between two lateral incisions, ih in. long, placed just below the uterine cornua arid as far outward as possihlc without injuring the vessels. Forceps burrow under the peritoneum from the central to the lateral incisions, grasp the loops of round ligament which have been brought through an opening in the broad ligament, and draw it through the canal. The two loops are sewn together and the junction covered by re-uniting the central incision. Bagley claims this makes a firmer support, besides preventing adhesions, as the sutures are covered by peritoneum. I%. F,. ~OBCS.