The subsequent treatment consists of frequent washing of the interior of the cyst. The sutures in the cyst-wall should be removed at the end of two weeks.
Though marsupialization frequently results in cure, yet it should never be practised unless it is absolutely necessary. It exposes the patient to the dangers of prolonged suppuration and persistent fistula. Malignant degeneration has occurred in the wound. Papilloma may extend to the peritoneum. The procedure is of but little use in the case of multilocular tumors, as all the loculi cannot be evacuated.
OPERATION FOR REMOVAL OF THE UTERUS.
The uterus may be removed through an abdominal incision (abdominal hysterectomy), or it may be removed through the vagina (vaginal hysterectomy). A combination of the two methods of operating is sometimes employed.
In many conditions it is not necessary to remove the cervix. Partial hysterectomy or supra-vaginal amputation of the uterus at some convenient point of the cervix may be performed.
Such supra-vaginal amputation of the uterus may be done in nearly all operations that are not performed for malignant disease. In sarcoma or cancer the whole uterus should be removed at the vaginal junction, and, if necessary, the upper portion of the vagina should be excised.
In the case of fibroid tumor and in non-malignant disease of the body of the uterus supra-vaginal amputation is sufficient. Supra-vaginal amputation is an easier and safer operation than complete hysterectomy. Abdominal hysterectomy is most easily performed with the patient in the Trendelenburg position.
Supra-vaginal Amputation of the Uterus.—After the abdomen has been opened, the ovarian artery should be ligated in the infundibulo-pelvic ligament, as in the operation of salpingo-oöphorectomy. A second ligature, or forceps, should then be placed upon the ovarian artery at the uterine cornu.
The round ligament should then be ligatured with medium-sized silk at a point situated about an inch from the uterus. Similar ligatures should then be placed about the ovarian artery and the round ligament on the opposite side.
