Identifier: americanjournalob06ameruoft (find matches)
Title: American journal of obstetrics and gynecology
Year: 1920 (1920s)
Authors: American Gynecological Society
Subjects: Gynecology Gynecology Obstetrics Obstetrics
Publisher: St. Louis : C.V. Mosby Co.
Contributing Library: Internet Archive
Digitizing Sponsor: Internet Archive

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FiK. 1.—.-^iit side have been clamped and incised and fascial flaps have been re-flected from the vaginal wall on either side. The hernial opening isclosed by suture of the free edges of the vaginal flap to the cervix atabout the level of the internal os. One or two sutuies for this pur-pose are generally inserted before the ))road ligament clamps areremoved but are not tied, as tying them nuiy interfere with accuratesuture of tlic free edges of the lu-oad liuaniciit. Tlio suture ilhis- WATKINS: CYSTOCELE AND HIGH RECTOCELE 393 trated is inserted for the purpose of controlling the bleeding fromthe broad ligament and for the purpose of approximating the freeedges of the broad ligament in front of the cervix. The sutures forclosure of the hernia are first tied and then the sutures which includethe cut ends of the l)road ligaments are tied. One or two additionalchromic catgut sutures are inserted if need be to obtain firm closure
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-RecluCL-le anil of the hernia. It will he found that by this means the urethral canalhas been restored to its normal position and the cure of urinary in-continence is assured. Care should be used that excessive tractionis not made upon the urethra. This can be obviated by seeing thatthe urethra is left only in a relative state of fixation. (The amountof mobility of the urethra is generally proportionate to the extentof the urethrocele.) 394 THE AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY Some plastic work is frequently required upon the cervix. Thismay consist in excision of the anterior lip or in amputation of thecervix, depending upon the requirements in the individual case. Theoperation is completed by the excision of any redundant mucosa andclosure of the mucous membrane wound. In making the mucousmembrane closure it is well to include some of the fascia or cervix ineach suture for the purpose of obtaining increased firmness.

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