Manual of gynecology / by D. Berry Hart and A.H. Freeland Barbour.

  • Hart, D. Berry (David Berry), 1851-1920.
Date:
1905
Catalogue details

Licence: Public Domain Mark

Credit: Manual of gynecology / by D. Berry Hart and A.H. Freeland Barbour. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    toneum, so that should any of it have escaped into the peritoneal cavity, time should not be wasted in attempting to remove it all completely; as much is removed as can be done quickly and without injury to the peritoneal surfaces. This, however, should not make the operator careless in preventing the escape of fluid into the abdominal cavity. If the cyst contents have been very gelatinous more careful cleansing is required for fear of the subsequent development of pseudomyxoma peritonei. Drainage. In ordinary simple cases drainage is not required, and the oftener it can be dispensed with in complicated cases the better, as, besides retarding the primary healing of the wound, it greatly increases the subsequent risk of hernia. For this latter reason, we should if possible, drain through the vaginal roof, and not from the abdominal wound in those cases where drainage is imperative, e.g., when the tumour has contained pus and there has been soiling of the peritoneum, or where oozing from the breaking down of extensive adhesions cannot be properly controlled. The best drain to use is probably one of sterilised iodoform gauze. This has to a large extent superseded the perforated glass and rubber tubes formerly so extensively employed. The gauze is lightly laid into the pelvis, and its end left in the lower angle of the abdominal wound or in the vagina, according as the drainage is from above or below. The time it is left in varies in different cases. When it has been employed for fear of haemorrhage it can be safely removed in forty-eight hours and the wound allowed to close. This also applies to cases where peritoneal infection was feared, provided there is no dis- charge and no symptoms of peritonitis. Should there be a discharge of pus or symptoms of peritonitis the original drain must be removed and a fresh strip of gauze substituted, and the wound allowed to close up from below, fresh gauze being inserted each day ; or after a few days a rubber tube may be substituted for the gauze, and the cavity syringed out daily through this. CLOSURE OF ABDOMINAL WOUND. The operator having satisfied himself that the operation is safely finished, i.e., that no haemorrhage is going on, that the pedicle is right, and the swab and instrument count correct, has now to close the wound. The omentum is pulled down so as to cover the intestine; a swab is passed below the incision so as to cover this and soak up any blood from the stitch punctures. The methods of suturing employed are various, viz. :— 1. Through and through with silk or silkworm gut. 2. Tier suture, all catgut; or catgut for peritoneum, with wire or silkworm gut for fascia and catgut for fat and skin.