Fig. 75.—A. The anterior vaginal wall is pushed backward by the staff, while on each side of the median line portions of mucous membrane are grasped by tenacula and brought together in order to determine the position of the strips to be denuded. B. Denudation on the anterior vaginal wall (Sims’ operation).
Fig. 76.—A. The sutures have been introduced. The prolapsed vagina and cervix have been reduced. The cystocele is pushed upward by the staff, so that the denuded strips may be brought into apposition. B. The sutures are secured. The cystocele has disappeared. The area of the anterior vaginal wall and the caliber of the vagina have been much diminished.
Fig. 77.—A. A point on the median line of the posterior vaginal wall, about an inch below the cervix, has been seized by the tenaculum. This marks the apex of a triangle the base of which is at the ostium vaginæ and the sides of which are on the lateral vaginal walls. B. The triangle has been denuded. The sutures have been introduced.
Whenever there is hypertrophy of the infra-vaginal cervix, this structure should be amputated in addition to the other operations.
Fig. 78.—The sutures in the posterior vaginal wall have been secured. The caliber of the vagina has been very much diminished. A strong sling or band of tissue has been formed immediately above the ostium vaginæ, which supports the lower portion of the posterior vaginal wall. The operation is completed.
In those very rare cases of incurable prolapse that have resisted all conservative treatment the operation for the removal of the uterus may be considered. The writer has never resorted to it. The operation consists in supra-vaginal hysterectomy followed by fixation of the cervical stump by sutures to the abdominal wall.
This operation, however, should not be proposed hastily. The surgeon should not become discouraged by one or even two failures of the more conservative methods of treatment. Though the first plastic operation may fail to retain the uterus inside the body, yet something is always accomplished by it, and when supplemented by a second or a third operation, cure will often result.