Various methods of dealing with the pedicle in ovariotomy / by J. Knowsley Thornton.

  • Thornton, J. Knowsley.
Date:
[1880?]
Catalogue details

Licence: Public Domain Mark

Credit: Various methods of dealing with the pedicle in ovariotomy / by J. Knowsley Thornton. 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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    and direct obstruction, and if it be to some other part it may form a bridge, under which a coil of intestine may become adherent or strangulated, and thence may follow indirect obstruction. It may be as well here to allude to another objection which has been raised to the complete intra-peritoneal ligature, and that is the risk of haematocele, similar in origin to that occurring externally after the use of the clamp. That this is extremely unlikely is theoretically apparent when we study the above processes of repair and obliteration of the stump. And as a practical proof of the truth of the theory, I may mention that I have only had one case of haematocele occurring after ovariotomy in over 170 cases treated by the complete intra-peritoneal method, and that was in a case of twisted pedicle—the vessels and tube being obliterated by the twisting, and consequent inflammatory changes, before I ligatured it,—and the hsematocele came on so distinctly after chill at the period-time that I think it is quite likely it was altogether independent of the pedicle and of the operation. I have little to add to the advice I gave in the paper from which I have quoted as to the kind of ligature and the method of applying it. No. 3 or 4 Chinese silk, applied by one or more transfixions, according to the breadth of the pedicle, each loop inter- locking with its neighbour so that a perfect chain is formed. In my previous paper I advocated the use of a special fine ligature, applied so as to include the veins of the pampini- form plexus in the outer part of the pedicle, “ whenever the outer edge of the broad ligament feels tight as one passes the fingers along it.” I now always use this special ligature, and I may take the opportunity of saying that I was the first to use it in the Samaritan Hospital, and also the first to advocate and use the complete interlacing of ligatures in pedicles in which a single transfixion does not afford sufficient safeguard against haemorrhage.* I have recently made * In the discussion which followed the reading of this paper, Mr. Bryant called my attention to a paper of his in the Guy’s Hospital Reports, vol. xiv., 1868, which clearly proves his claim to priority as having been the first advocate of this very important detail. He actually figures the locked ligatures, and also gives some valuable experience in ligature of the ovarian pedicle which I had overlooked.
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