A Text-book of Diseases of Women

by Charles B. Penrose

The denudation, which may be made with a knife or with scissors curved on the flat, should be begun upon the lower lip. The tissue to be removed may first be marked out with the knife. The tissue to either side of the old external os is seized with a tenaculum or with toothed tissue-forceps, and a strip is elevated by an incision extending into the angle of the tear. A corresponding opposite portion of tissue on the anterior lip is then seized in a similar manner, and a similar strip of tissue is excised, meeting and joining the strip first raised in the angle of the tear. We thus remove a wedge-shaped portion of tissue. The operation is then repeated upon the other side. The strip of mucous membrane that is left on the center of the lips to form the new cervical canal should be about a quarter of an inch in width.

If the finger be passed over the freshened surfaces, small indurated masses of tissue are sometimes felt. Such tissue should be caught with the tenaculum or the forceps and excised. This condition is most usual when the tear has been of long standing and the cervix has undergone sclerotic changes. It is important that the excision of tissue should be carried well up in the angle of the laceration, in order that all hard cicatricial tissue may be excised.

The excision of tissue should be done as nearly as possible in the plane of the laceration. A frequent mistake is to remove too much tissue from the vaginal aspect of the cervix.

There is usually but little bleeding in the operation of trachelorrhaphy, and whatever bleeding there is may always be controlled by properly placed sutures.

The first suture should embrace the angle of the laceration. It should be introduced on the vaginal aspect of the cervix, near the edge of the mucous membrane, and should emerge on the edge of the mucous membrane of the cervical canal. It should then be reintroduced at a corresponding point on the opposite lip, and should emerge on the mucous membrane of the vaginal aspect. It is often difficult to bring the first suture out on the mucous membrane of the cervical canal. This, however, is not necessary if the suture embraces the whole of the denuded angle.

The other sutures, usually two or three in number, are introduced in a similar manner near the edge of the mucous membrane of the vaginal aspect, pass around the whole of the denuded surface, and emerge on the mucous membrane of the cervical canal, near the edge. They are then re-introduced on the opposite lip, and emerge at a corresponding point on the vaginal aspect of this lip.

A frequent mistake is to bring the sutures out on the raw surface so that the lateral union of the torn lips is shallow and superficial, often consisting only of the thickness of the mucous membrane of the vaginal aspect of the cervix. As the result of such an operation the new-formed cervical canal is spindle-shaped, much broader than normal, and the condition of an incomplete laceration of the cervix results.

Fig. 104.—Steps of the operation of trachelorrhaphy for bilateral laceration of the cervix uteri: A, bilateral laceration with erosion; B, the area to be denuded has been marked out with the knife; C, the denudation has been accomplished; D, sutures introduced; E, completed operation.

After the operation the vagina should be washed out with a 1:2000 solution of bichloride; it should then be dried with sponge or gauze, and a light vaginal pack of sterile gauze should be introduced.