A Text-book of Diseases of Women

by Charles B. Penrose

In performing the operation it is important that every portion of ovarian tissue should be removed, and that the Fallopian tube should be amputated as closely as possible to the uterine cornu. Many cases of failure of this operation are due to neglect of these precautions.

A very small portion of ovarian tissue may be sufficient to continue menstruation.

A good many women who had derived no benefit from the first operation have been subjected to a second operation, a small remaining portion of the ovary being removed or the stump of the Fallopian tube being excised, complete cure resulting.

The nature of the influence of the Fallopian tube in this matter is not understood. Tait lays especial stress upon the necessity of its complete removal.

The importance of the removal of the tubes may be realized from Tait’s statement that “removal of the ovaries alone is followed by immediate and complete arrest of menstruation in about 50 per cent. of the cases. Removal of both tubes, with or without the ovaries, is followed by the same arrest in about 90 per cent. of the cases.” From this statement it appears that if one wishes to stop menstruation, removal of the tubes is of even more importance than removal of the ovaries.

The operation of salpingo-oöphorectomy is not advisable in some cases, and in some others it is impossible to perform it.

As has already been said, the operation is likely to fail in the soft edematous fibroids. It should not be advised in the fibro-cystic tumors. It is not advisable in the case of large fibroid tumors of abdominal growth, because, even though atrophy occur, it will be slow, and the symptoms referable to the large hard tumor in the abdomen will be but slowly relieved.

The operation is not applicable to the intra-ligamentous fibroid of pelvic growth, producing urgent pressure-symptoms that demand certain and immediate relief. In the case of profuse exhausting hemorrhage, when the anemia is so great that immediate and certain arrest of bleeding is required, salpingo-oöphorectomy should not be practised.

If the woman has reached the menopause, and, notwithstanding the cessation of menstruation, the tumor continues to grow, salpingo-oöphorectomy will do no good.

In some cases the tubes and ovaries cannot be removed. They often occupy a position behind or under the tumor, so that they cannot be removed without first taking the tumor away. The tube and ovary may be so distorted that only partial excision is possible, and this will result in no benefit; or the tube and ovary may be spread out upon the face of the tumor, incorporated with its capsule, so that removal is impossible, and any attempt at removal may result in rupture or penetration of large venous sinuses—a most dangerous accident.