Part 3 (1/2)

REFERENCES

DORAN, A. On complete Intraperitoneal Ligature of the Pedicle in Ovariotomy. _St. Bartholomew's Hospital Reports_, 1877, xiii. 195.

---- Pregnancy after the Removal of Both Ovaries for Cystic Tumour.

_Trans. Obstetrical Society_, 1902, xliv. 231.

BLAND-SUTTON, J. On Secondary (metastatic) Carcinoma of the Ovaries.

_Brit. Med. Journal_, 1906, i. 1216.

---- On Cancer of the Ovary. Ibid., 1908, i. 5.

LE BEC. Ovariotomie double; un des kystes enleve par la region lombaire, l'autre par le devant de l'abdomen; adherences totales; guerison.

_Gaz. des Hopitaux_, 1887, 290.

STOCKS. Prolapse of an Ovarian Cyst. _Brit. Med. Journal_, 1857, ii.

487.

PETERS, H. Ovariotomie per anum. _Wiener Klin. Wochensch._, 1900, xiii.

110.

CHAPTER III

OoPh.o.r.eCTOMY

_Ooph.o.r.ectomy signifies the removal through an abdominal incision of an ovary and Fallopian tube for affections mainly inflammatory._

The evolution of this operation is of great interest to surgeons. The removal of ovaries as a surgical operation was introduced independently by Hegar in Germany and Battey in Georgia, for the relief of pelvic pain and dysmenorrha, in 1872. In the same year Lawson Tait performed his pioneer operation and removed an ovary and tube for the relief of pain due to disease of the ovary. Subsequently he advocated bilateral ooph.o.r.ectomy for the purpose of inducing an artificial menopause in women with uterine fibroids. From these beginnings the operation began to be performed for the relief of a variety of conditions connected with the generative organs, such as--

Pyosalpinx and tubo-ovarian abscess, hydrosalpinx, tuberculous ovaries and tubes, sarcoma and carcinoma of the Fallopian tubes, gravid Fallopian tubes, ovarian abscess, ovarian pregnancy, prolapse of the ovary; finally bilateral removal of the ovaries has been practised for the relief of inoperable cancer of the breast.

Bilateral ooph.o.r.ectomy is occasionally performed for osteomalacia (a rare disease in Great Britain), as it arrests pain and the excessive output of phosphates in the urine, which is a marked feature of this affection. This extension of the operation we owe to Fehling of Bale (1887).

Time and experience have considerably modified surgical opinion in regard to ooph.o.r.ectomy. Removal of the ovaries is no longer practised for the relief of haemorrhage due to fibroids: it is easier, safer, and affords greater relief to the patient to remove the uterus (see p. 36).

When dysmenorrha is so severe as to need radical operation, hysterectomy is the only certain method, with conservation of at least one ovary. The removal of both ovaries in certain forms of insanity is now abandoned, and this is true of bilateral ooph.o.r.ectomy for the relief of mammary cancer.

In other directions the operation has undergone extension, for in some chronic diseases of the Fallopian tubes it is difficult to completely extirpate the affected tissues without removing the uterus. These will be considered in describing the actual operation.

Apart from the many modifications in the details of the operations some operators prefer to remove the ovaries and tubes through an incision in the v.a.g.i.n.al fornix. This is known as Colpotomy, or v.a.g.i.n.al Cliotomy.

Some writers attempt to subdivide the various modifications of ooph.o.r.ectomy and apply to them special terms: for example, the removal of the ovary and tube would be termed salpingo-ooph.o.r.ectomy. Removal of the tube would be called salpingectomy, and the excision of the ovary, ooph.o.r.ectomy. This terminology may be precise, but it is certainly clumsy. A few writers designate these operations as 'removal of the uterine appendages'; this phrase, though comprehensive, is neither precise nor elegant.

=Operation.= The patient is prepared in the same manner, and the same instruments are required, as for ovariotomy. In many of these operations the Trendelenburg position is of the greatest advantage.

[Ill.u.s.tration: FIG. 3. AN INFECTED FALLOPIAN TUBE. The clomic ostium of the tube is unoccluded and is in the process of slowly engulfing the fimbriae. Removed from a woman in the acute stage of salpingitis.