The vessels are secured in their course by ligatures which embrace a minimum amount of surrounding tissue. In the early days of modern abdominal surgery, the operation usually advised was performed with the Tait knot ([Fig. 211]) or the link-ligature ([Fig. 212]).
| Fig. 211.—The Tait knot. | Fig. 212.—The link-ligature. |
The ovary and the tube are drawn into the abdominal incision, and the pedicle formed by the broad ligament is transfixed with the pedicle-needle carrying a double ligature.
The loop of the ligature is passed over the tube and ovary and the Tait knot is tied, or the ligature is cut and each half of the pedicle is separately secured, the ligature being crossed or linked in the middle of the stump, to prevent separation.
The operators who apply the ligature in this way do so because they fear hemorrhage if every portion of the broad ligament is not secured.
This fear is unfounded. The objections to this form of ligature, the Tait or the link-ligature, may be given by the following quotation from a former paper by the writer.[4]
“The objections to these ligatures are: The liability to slip; the difficulty or impossibility in some cases of removing all the ovary and tube; the fact that the broad ligament is puckered up and made more tense than normal, and may for this reason cause subsequent pain and discomfort; an unnecessary amount of tissue is strangulated.
“Most operators have seen cases, either in their own experience or in the experience of others, in which the ligature has slipped from the pedicle, either during the operation or some days afterward. I think that this accident, usually unrecognized, is a very common cause of death after oöphorectomy. Tait speaks of a certain number of cases in his own experience in which a hematoma occurred in the broad ligament some hours or days after operation. He says, ‘I cannot form any exact estimate of how many cases of these operative hematoceles I have seen, but it certainly is not less than 50, and is more likely to be 70 or 80.’
“It seems probable that this accident is due to the retraction or slipping of the artery from the embrace of the ligature, while the remaining mass of tissue which forms the pedicle is still retained, and the hemorrhage, therefore, is confined to the broad ligament. I have seen this accident happen before the abdomen had been closed, and have sought for and ligated separately the retracted vessel.
“Slipping of the ligature is due to the form of the mass of tissue which is ligated. The broad ligament is drawn up into a more or less conical shape, all parts converging toward the ligature, and the ligature is really placed at the apex of a cone from which it may readily slip; and the elastic artery, tied when upon the stretch, tends to retract and escape from the embrace of the ligature.