LESSON 2: Procedures in Gynecological and Obstetrical Surgery

Section Ii: vaginal surgery

2-21

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2-21. TRACHELORRHAPHY

a. General. This operation involves removal of torn surfaces of the anterior and posterior cervical lips and reconstruction of the cervical canal. It is done to treat deep lacerations of a cervix (1) that is relatively free of infection and (2) in women past the childbearing age.

b. Operative Procedure.

(1) The labia are retracted with Allis-Adair forceps or sutures. The cervix is grasped with a Jacobs vulsellum forceps.

 

(2) The affected tissue of the exocervix is denuded with a knife. The flaps are undermined by means of a knife and curved scissors. Bleeding vessels are clamped and ligated. The mucosa is dissected from the cervix.

 

(3) A small distal portion of the cervical canal is coned to remove infected tissue by means of a knife. Bleeding vessels are clamped and ligated with chromic gut number2-0 ligatures.

 

(4) The denuded and coned areas are covered by suturing and mucosal flaps of the exocervix transversely, using six to eight interrupted chromic gut number0 sutures swaged to 1/2-circle, trocar-point needles. Tissue forceps, hemostats, and sponges on holders are needed. The sutures are placed in such a manner that the fibromuscular tissue of the cervix is included, thereby eliminating dead space where a hematoma may form and providing a complete reconstructed cervical canal.

 

(5) The wound is cleansed and dressings are applied and held in place with a binder. A retention catheter may be introduced in the bladder.

 

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