Indications for the operation of supravaginal amputation of the uterus:
- After cesarean section with hypotension of the muscles of the uterus;
- In the presence of uterine fibroids and pregnancy;
- In the case of hypotonic subcompensated bleeding in the follow-up;
- With obstetric peritonitis of different etiology;
- When performing cesarean section in conditions of infection of the body of a woman.
Technique for the operation of supravaginal amputation of the uterus
After opening the abdominal wall, the middle median lapotomy is seized and examined by the uterus. Then divert it to the side, apply two clamps - one on the round ligament of the uterus, the second - on your own ovarian ligament and uterine tube. To prevent reverse venous hemorrhage, counter-gliomas are applied. These formations are crossed, pierced, ligated. The upper edge of the broad ligament is dissected between the superimposed clamps. Clamps are replaced by ligatures. The uterus is diverted to the opposite side by the same actions. Then, pulling the uterus back, dissect the bladder and uterine fold, the bladder is separated from the cervix and the peritoneal incision continues in both directions. Pulling the uterus aside place clamps and counterclams on the uterine vessels, bandaging them, crossing the shift ligatures from both sides.
At the level of the internal pharynx, the uterus is cut off from the cervix. On the cervix stump, 3-4 joints are stitched with sutures, which connect the anterior and posterior parts of the cervix.
Peritonization is performed by a continuous catgut suture. First, pierce the back of the cervical stump with a thin needle, then the corresponding edge of the peritoneum of the vesicle-uterine fold. The cervical stump is covered by the peritoneum. Then the peritonization of the Celts of the circular ligament and appendages continues with the same ligation. Apply a suture stitch. After tightening the pouch, the stumps of the cervix and appendages are immersed in the pocanocerean space.
After monitoring for hemostasis and revision of the abdominal cavity, the abdominal wall is sutured layer by layer.