(3) In either procedure, bleeding of the vaginal wall is controlled by sutures
of chromic gut number 2-0; dressings are applied to the wound surface and held in
place with a binder.
2-32. FOTHERGILL-HUNTER OPERATION FOR PROLAPSE OF THE UTERUS
a. General. This procedure, following D and C, involves a complete repair of
the vaginal walls. This is done from above downward, correcting faulty supportive
structures of the pelvic floor. It is usually done on women of childbearing age who
desire preservation of the childbearing function.
b. Operative Procedure.
(1) Dilatation of the cervix and curettage of the uterus is done, as previously
described in paragraph 2-24.
(2) An inverted V incision is made through the full thickness of the vaginal
wall. It extends from the bladder reflection to the urethral meatus.
(3) The cervix is circumscribed and bleeding vessels ligated. A knife,
Allis-Adair forceps, hemostats, tissue forceps, moist sponges on holders, and chromic
gut number 2-0 ligatures are used.
(4) The mucosal flaps are dissected free laterally and posteriorly to expose
the cardinal and uterosacral ligaments, which are clamped, ligated, and cut close to the
cervical sutures. The cardinal and uterosacral ligaments containing vesical arteries are
secured with chromic gut number 0 or 2-0 sutures swaged to 112- circle, taper-point
(5) The cervix is amputated at a site to permit shortening of the ligament.
The remaining portion of the cervix is grasped with a Jacobs vulsellum forceps. The
rectovaginal septum is exposed by blunt and sharp dissection.
(6) The upper portion of a rectocele is repaired, as described for posterior
vaginal plastic repair. A wedge-shaped incision is made with a knife in the portion of
vaginal wall to be removed. Repair is performed, using an inverting suture to bring the
flaps of the vagina over the sutured fibromuscular tissue of the cervix. Interrupted
sutures, chromic gut number 0 swaged to 1/2- circle, trocar-point or taper-point needles
are placed to approximate the posterior wall.
(7) Cardinal ligaments are sutured in the midline with interrupted sutures of
chromic gut number 0 to shorten the parietal connective tissue, thereby permitting them
to provide more support for the pelvic floor.
(8) An anterior and posterior Sturmdorf-type suture is placed in the upper
and lower vaginal wall. Flaps are grasped with Allis forceps, the excised vaginal wall is