resected on each side using Metzenbaum scissors, and the anterior vaginal wall is
closed and reconstructed.
(9) A plastic reconstruction of the genital aperture is done, using interrupted
chromic gut number-O and 2-0 sutures. The musculature of the perineum is
reconstructed by placement of sutures in such a way that the bulbocavernosus and the
remaining transverse perineal muscles decrease the genital aperture and add support
of the pelvic viscera.
(10) A urinary drainage system is established, packing is placed in the
2-33. COLPOCLEISIS (LE FORT OPERATION) FOR PROLAPSE OF THE UTERUS
Colpocleisis is the closure of the vagina by approximation of the anterior and
posterior vaginal walls, with or without an attendant vaginal hysterectomy. The patient
must be apprised of the fact that she will no longer possess a functioning vagina.
2-34. VAGINAL HYSTERECTOMY
a. General. In this procedure, the uterus is removed through an incision in the
vaginal wall. This may be done unless there is pelvic malignancy or a large uterine
tumor, both of which call for abdominal surgery.
b. Operative Procedure.
(1) The labia are retracted back with sutures of silk or chromic gut number
2-0 swaged to 3/8 circle, cutting-edge needles held by Crile short needle holders.
Tissue forceps and suture scissors are needed. An Auvard or Sims vaginal retractor is
inserted to retract the vaginal wall.
A D and C is performed.
(3) A Jacobs vulsellum forceps or chromic gut number0 suture ligature is
placed on both the posterior cervical lips to permit traction of the cervix.
(4) The vaginal wall is incised. The incision is made anteriorly on the cervix
through the full thickness of the wall. The bladder is pushed off the cervix by the knife
handle; the bladder is freed from the anterior surface of the cervix and positioned with
(5) The vesicouterine peritoneum is carefully opened and the incision is
extended laterally as far as the broad ligament. The body of the uterus and the adnexa
are palpated and the fundus is delivered through the opening.