Hernia rarely occurs, for the opening in the peritoneum is of very small size.
In rare cases, and when care is not used, a portion of the intestine may be sutured to the margin of the wound. The intestine then becomes adherent to the abdominal wall, but grave results seldom follow.
SUTURE OF THE VULVA
In cases of recurrence after reduction of an inversion of the uterus or the vagina it may become necessary to suture the vulva in order to control the effects of straining.
Several forms of suture are employed; the best are probably those of Rainard and Strebel.
Simple Suture.—Simple suture may be formed of very flexible copper wires. Three are usually inserted, one at the base, one about the middle, and one near the upper third of the vulval opening. The ends of each suture are knotted and drawn moderately tight over the opening, then one of the ends of the highest knot is united vertically to an end of the middle knot, and the latter in its turn is similarly secured to the lowest knot.
To be reliable, sutures should embrace the entire thickness of the lips of the vulva.
Rainard’s Suture.—Rainard’s suture consists only of two oblique stitches, crossed in the form of the letter “X,” starting from the upper third of one of the lips of the vulva and terminating in the lower third of the opposite lip. The ends are tied opposite the centre of the vulval opening.
Strebel’s Suture.—Strebel’s suture consists of three stitches inserted transversely. The material employed is galvanised wire, sharpened at one end and rolled into a flat spiral at the other. Each wire, which plays the part of a needle, is inserted separately, and is afterwards twisted into a spiral by means of special forceps, the excess of length being thus taken up until the lips of the vulva are brought closely in contact.
