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Systematized Ligamentopexy in Conservative Gynecology
Department of Reviews and Abstracts Cmmucn]D
BY
HrGo EIIREXFEST, :M.D.
Selected Abstracts GYNECOLOGIC OPERATIONS Jonas, Emil:
Simpli1l.ed Technique of Abdominal Supravaginal Hysterectomy,
Illinois M. J. 68: 347, 19i15. The author lists 6 positions where fibromyomas may be founl! when the peritoneum is opened. Each position necessitateR a slight modification in the technic, which is as follows: one clamp is placed on the insertion of the round ligament into the uterus. A No. I chromic catgut suture is placed laterally to the clamp, and the ligament cut between clamp and suture. The process is repeated on the fallopian tube and the ovarian ligament, hilaterally. Each suture is left long and held by a separate forcep~. '1'he sutures are now raised so that the two layers of the broad ligament can be separated. 'l'he anterior layer on each side is (Out downward in the direetion of the cervix, keeping close to the uterus. 'l'he bladder is pushed away and a transverse incision is made on the anterior layer froUl one side of the cervix to the other. The uterus is delivered through the abdominal opening hy means of traction forceps and the bladder elevated with a narrow retractor. A cut corresponding to that made in the anterior layer is now made in the posterior layer of the hroad ligament, and the terminal cut ends are pushed downward, exposing the uterine vessels. 'l'hese are now ligated as follows: using No.1 chromic catgut and a cervical needle two mass sutures are taken into the cervical tissue one-half inch apart and one-half inch from the cervix. The long ends of these sutures are tied on the anterior wall of the cervix. Another ligature, carried by an aneurysm needle, is placed between these two sutures. A transverse cut now amputates the (·ervix. "Csual treatment of the stump and peritoneum follows.
Loute, L.:
Systematized. Ligamentopexy in Conservative Gynecology, Presse med.
84: 1628, 1935.
The physical factors responsible for the maintenance of the normal position of the uterus are reviewed, and the mechanism of acquired retrodisplacements of the organ is discussed. The author presents his modification of the round ligament shortening operation by Doleris, and advocates the method for correction of either existing retrodisplaeement or as a routine procedure in any conservative gynecologic operation to prevent future displacements. Technic: Pfannenstiel incision. The round ligaments are cut laterally at their \lntrance into the internal inguinal ring and the distal segment is ligated. Each 174
ABSTRACTS
175
rectus muscle is perforated with forceps obliquely at the level of the internal ring through the middle inguinal fossa about a centimeter medial to the deep epigastric artery. ·With forceps the free ends of the round ligaments are drawn through the oblique tract and sutured to each other in front of the recti. Abdominal wall closed in usual manner. Following advantages are stressed: Simple operative technic based upon anatomic and physiologic principles, with practically no operative risk; good immediate and remote results (checked by pelvic examinations and hysterography); no detrimental effect on fecundity, pregnancy, delivery or postpartum state. ARKOLI) GOLDBERGER.
Thoma, E.: The Alexander-Adams Operation. Results of an Investigation of 200 Operations, Monatschr. f. Geburtsh. u. Gyniik. 103: 49, Hl36. In a series of 200 Alexander-Adams suspension operations the author reports recurrences in only 1 per cent as far as the anatomic results were concernel!. Concerning functional results, the operation was a success in 91 per cent of the cases. Only 2.5 per cent of the patients actually claimed they were not helped by the operation. There was only 1 al)dominal hernia in this series. Pregnancy followed in 13.5 per cent of these patients and complications did not occur in a single one during labor. J. P. GREE)'IHILL. Sigwart, W.: Ventral Suspension of the Uterus and Its Permanent Results, :Monatschr. f. Geburtsh. u. Gyniik. 102: 286, 1936. The author claims the following advantages for his operation for ligament suspension of the uterus: There is no danger of ileus. 'rhe uterus is placed both in a practical and physiologic position. Other disturbances do not occur and during subsequent pregnancies and labors there are no complications. There are no disturbances as a result of the fixation of the round ligament . •T. P. GREE)'IIIII,L.
Goulart de Andrade, Claudio: The Treatment of Prolapse of the Uterus by Halban's Operation, Rev. de gynec. e d'Obstet. (Rio de Janeiro) 29: 631, 1935. The writer reports in detail two cases of complete prolapse of the uterus operated by a modified Halban's technic which in his belief proves highly satisfactory for this type of case. :1<'. L. ADAIR AND .T. Sl;AREZ. Brandt, T.: A Tubo-Uterine Method of Permanent Sterilization, Acta obst. et gynec. Scandinav. 16: 160, 1936. In the author's method of producing permanent sterilization in women he first places a ligature about 1 cm. below the uterotubal junction on each fallopian tube. This affixes the tubes to the uterus. He then proceeds to make the usual uterotubal excision and closes the wound in the uterine corner with two Lembert stitches. The raw surface is then completely peritonealized with the round ligament although this part of the operation is not essential. "'he operation can readily be performed in three minutes, it is bloodless, anl! the results according to the author are excellent. J. P. GREEKIIILL.
BY
HrGo EIIREXFEST, :M.D.
Selected Abstracts GYNECOLOGIC OPERATIONS Jonas, Emil:
Simpli1l.ed Technique of Abdominal Supravaginal Hysterectomy,
Illinois M. J. 68: 347, 19i15. The author lists 6 positions where fibromyomas may be founl! when the peritoneum is opened. Each position necessitateR a slight modification in the technic, which is as follows: one clamp is placed on the insertion of the round ligament into the uterus. A No. I chromic catgut suture is placed laterally to the clamp, and the ligament cut between clamp and suture. The process is repeated on the fallopian tube and the ovarian ligament, hilaterally. Each suture is left long and held by a separate forcep~. '1'he sutures are now raised so that the two layers of the broad ligament can be separated. 'l'he anterior layer on each side is (Out downward in the direetion of the cervix, keeping close to the uterus. 'l'he bladder is pushed away and a transverse incision is made on the anterior layer froUl one side of the cervix to the other. The uterus is delivered through the abdominal opening hy means of traction forceps and the bladder elevated with a narrow retractor. A cut corresponding to that made in the anterior layer is now made in the posterior layer of the hroad ligament, and the terminal cut ends are pushed downward, exposing the uterine vessels. 'l'hese are now ligated as follows: using No.1 chromic catgut and a cervical needle two mass sutures are taken into the cervical tissue one-half inch apart and one-half inch from the cervix. The long ends of these sutures are tied on the anterior wall of the cervix. Another ligature, carried by an aneurysm needle, is placed between these two sutures. A transverse cut now amputates the (·ervix. "Csual treatment of the stump and peritoneum follows.
Loute, L.:
Systematized. Ligamentopexy in Conservative Gynecology, Presse med.
84: 1628, 1935.
The physical factors responsible for the maintenance of the normal position of the uterus are reviewed, and the mechanism of acquired retrodisplacements of the organ is discussed. The author presents his modification of the round ligament shortening operation by Doleris, and advocates the method for correction of either existing retrodisplaeement or as a routine procedure in any conservative gynecologic operation to prevent future displacements. Technic: Pfannenstiel incision. The round ligaments are cut laterally at their \lntrance into the internal inguinal ring and the distal segment is ligated. Each 174
ABSTRACTS
175
rectus muscle is perforated with forceps obliquely at the level of the internal ring through the middle inguinal fossa about a centimeter medial to the deep epigastric artery. ·With forceps the free ends of the round ligaments are drawn through the oblique tract and sutured to each other in front of the recti. Abdominal wall closed in usual manner. Following advantages are stressed: Simple operative technic based upon anatomic and physiologic principles, with practically no operative risk; good immediate and remote results (checked by pelvic examinations and hysterography); no detrimental effect on fecundity, pregnancy, delivery or postpartum state. ARKOLI) GOLDBERGER.
Thoma, E.: The Alexander-Adams Operation. Results of an Investigation of 200 Operations, Monatschr. f. Geburtsh. u. Gyniik. 103: 49, Hl36. In a series of 200 Alexander-Adams suspension operations the author reports recurrences in only 1 per cent as far as the anatomic results were concernel!. Concerning functional results, the operation was a success in 91 per cent of the cases. Only 2.5 per cent of the patients actually claimed they were not helped by the operation. There was only 1 al)dominal hernia in this series. Pregnancy followed in 13.5 per cent of these patients and complications did not occur in a single one during labor. J. P. GREE)'IHILL. Sigwart, W.: Ventral Suspension of the Uterus and Its Permanent Results, :Monatschr. f. Geburtsh. u. Gyniik. 102: 286, 1936. The author claims the following advantages for his operation for ligament suspension of the uterus: There is no danger of ileus. 'rhe uterus is placed both in a practical and physiologic position. Other disturbances do not occur and during subsequent pregnancies and labors there are no complications. There are no disturbances as a result of the fixation of the round ligament . •T. P. GREE)'IIIII,L.
Goulart de Andrade, Claudio: The Treatment of Prolapse of the Uterus by Halban's Operation, Rev. de gynec. e d'Obstet. (Rio de Janeiro) 29: 631, 1935. The writer reports in detail two cases of complete prolapse of the uterus operated by a modified Halban's technic which in his belief proves highly satisfactory for this type of case. :1<'. L. ADAIR AND .T. Sl;AREZ. Brandt, T.: A Tubo-Uterine Method of Permanent Sterilization, Acta obst. et gynec. Scandinav. 16: 160, 1936. In the author's method of producing permanent sterilization in women he first places a ligature about 1 cm. below the uterotubal junction on each fallopian tube. This affixes the tubes to the uterus. He then proceeds to make the usual uterotubal excision and closes the wound in the uterine corner with two Lembert stitches. The raw surface is then completely peritonealized with the round ligament although this part of the operation is not essential. "'he operation can readily be performed in three minutes, it is bloodless, anl! the results according to the author are excellent. J. P. GREEKIIILL.