c. Operative Procedure--Vesi-courethral Suspension (Marshall--Marchetti
(1) Through a suprapubic abdominal incision, the space of Retzius is
entered, and the bladder and urethra are freed from the surrounding structures.
(2) Mattress chromic gut sutures number1 or Mersilene number 0 are
inserted through the supporting fascia of the vaginal wall on either side of the urethra
and bladder neck; they are then passed through the muscle associated with the
symphysis pubis, thereby providing support to the urethra and bladder neck.
(3) Additional sutures are introduced in the lower and lateral portions of the
bladder wall and are attached to the posterior portion of the rectus muscles, thereby
pulling the bladder anteriorly to obliterate the space of Retzius.
The wound is closed and may be drained with a Penrose drain.
2-19. EXCISION OF FIBROMA OF THE VAGINA
a. General. This procedure involves the removal of the lesion through a
transverse or longitudinal incision of the wall of the vagina. Small cysts or small benign
tumors that distort the vagina or those that are ulcerated and infected are the kind of
lesions removed in this surgery.
b. Operative Procedure.
(1) The vaginal vault is retracted, using lateral and Sims retractors. Traction
sutures of chromic gut number 0 or silk number 2-0 are placed on each side of the
tumor. The posterior lip of the cervix is grasped with a Jacobs vulsellum forceps and
drawn anteriorly to expose the operative site.
(2) The vaginal wall is incised, and the edges are grasped with traction
sutures on curved, taper point needles or with Allis forceps.
(3) The cyst and its capsule are excised, using a knife and curved scissors;
bleeding vessels are clamped and ligated, using Halsted forceps and fine sutures.
(4) The vaginal incision is closed with interrupted sutures of chromic gut
2-20. CONSTRUCTION OF VAGINA
a. General. This operation involves taking a skin graft and then using it for
vaginal reconstruction to repair or overcome congenital or surgical defect.