The practice of surgery (1910) (14592583487)

Identifier: practiceofsurger00mumf (find matches)

Title: The practice of surgery

Year: 1910 (1910s)

Authors: Mumford, James Gregory, 1863-1914

Subjects: Surgery

Publisher: Philadelphia and London, W. B. Saunders company

Contributing Library: Columbia University Libraries

Digitizing Sponsor: Open Knowledge Commons

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to the ureters.These structures often are greatly displaced by myomata, and in thecase of extensive intraligamentous growths the ureters may appear 302 FEMALE ORGANS OF GEXERATION to be far out on the side of the tumor. For this reason, in the case ofdifficult dissections, some operators do their work after having passedcatheters through the urethra into the ureters. The vessels being now controlled and the ureters isolated, amputatethrough the cervix with knife or scissors. I prefer to make a fish-tailincision, which may readily be closed like any other amputation stump,and before closing the stump I rim out the cervical canal with the actualcautery, or swab it with pure carbolic acid. Then close the cervicalstump with buried catgut sutures. Draw over it and stitch in place thedissected peritoneum, and complete the operation b\ fastening the stumpof the round ligaments into the remnant of the cervix. I. regard thisstitching of the round ligaments into the cervix as important for the

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Fig. 184.—Suture of cervical stump (adapted from Dudley). support of the perineal floor. Sagging of the cervical stump is thus pre-vented and the bladder is kept properly supported. E. C. Dudley ad-vocates sewing the severed stumps of the broad ligaments to each otheracross the pelvis. This is an excellent maneuver when ))Ossible, butthe same end is attained by such a treatment of the round ligamentsas I have described. The question of leaving one ovary, or a portion of an ovaiy, in thepelvis has agitated men. It is certain that removal of both ovaries atonce from a woman who has not yet passed the menopause results inmore serious nervous disturbances than when ovarian tissue is left.After the menopause the removal of both ovaries causes less disturb-ance. TUMORS OF THE UTERUS 303 The aftor-troatmont of these cases is quite simple and consists in theusual care of diet and bowels, with rest in bed for from two to three

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1910

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