A consideration of some of the newer problems in abdominal and pelvic surgery in women / by Charles P. Noble.

  • Noble, Charles P. (Charles Percy), 1863-1935.
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: A consideration of some of the newer problems in abdominal and pelvic surgery in women / by Charles P. Noble. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    were removed and a hysterorrhaphy performed. One of the tubes had been transformed into a hydrosalpinx. The second case in which the uterus has not remained attached to the abdomi- nal wall was one in which on the third or fourth day the blad- der became over-distended and tore out the sutures from the uterus. This patient was apparently emptying her bladder and deceived her nurses in this way. Attention was called to the over-distention by abdominal pain, which on investigation was found to be due to a bladder sufficiently filled to extend up to the umbilicus. The relative merits of hysterorrhaphy and shortening of the round ligaments is a question which merits attention. In my judgment the field of suspension of the uterus is very much wider than that of shortening of the round ligameuts. The latter operation should be limited to those cases of retroversion or prolapse of the uterus in which the uterus is freely movable and the broad ligaments so flaccid as to assure the examiner that adhesions are absent or of a very trifling character. This last clause is added because adhesions of a very trifling character cannot be recognized by bimanual examination. Really the operation should be limited to cases in which adhesions are absent. On the other hand, suspension is applicable not only to this class of cases, but to cases in which adhesions more or less dense exist as a complication of the retroflexion or prolapse of the uterus. My preference is to shorten the round ligaments in cases having no adhesions, if the patient is young and liable to become pregnant, as I believe that pregnancy and labor are less likely to be interfered with than is the case when the uterus is attached to the abdominal wall. Hysterorrhaphy must be em- ployed whenever there are adhesions, and oftentimes when there are none. For example: Of the twenty-eight hysterorrhaphies reported to-night twelve have been done in cases of procidentia or retroflexion of the uterus in which plastic operations were also performed upon the same patient at the same sitting. In all such cases I prefer hysterorrhaphy because of the much shorter time which is required for its performance. Ten or fifteen minutes suffice for a carefully performed hysterorrhaphy, whereas it requires at least three-quarters of an hour to shorten the round ligaments. The interests of the patient are best sub- served by selecting hysterorrhaphy in cases in which it is neces-
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