Alexander-Adams Operation

ALEXANDER-ADAMS OPERATION (Alexander, Adams), - extraperitoneal shortening of the round ligaments, - proposed by Alquie and first performed by Alexander in 1881, and somewhat later by Adams. The purpose of the operation is to give the uterus an anteflexed position. With a bilateral incision parallel to the Poupart's ligament in the region of the inguinal canal, one reaches the aponeurosis of the external oblique muscle and exposes the external inguinal ring; the inguinal canal is opened and the round ligament of pale-pink color is found in it, on the surface of which a small tortuous artery is located, and along its outer edge - a branch of the ilioinguinal nerve. Having grasped the ligament, it is separated from the surrounding attachments and pulled out, moving away the adjacent peritoneal cone. The resulting loop of the ligament is either sutured to the aponeurosis or resected. The A.-A. operation became widespread in the treatment of retroflexion of the uterus, and also partially in its prolapse and descent. At present, the area of application of the A.-A. operation has significantly narrowed, since this operation is permissible only with a completely mobile uterus, which can be established only by opening the abdominal cavity. For this purpose, modifications of the A.-A. operation were proposed: the Goldspohn method, where when pulling out the round ligament, the peritoneum is opened; the anchor-shaped incision (Rumpf, Palm) and the transverse incision (Franz), in which the peritoneum is opened along the midline, the pelvic organs are examined, and only after that the A.-A. operation is performed ("Alexander laparotomy"). Mackenrodt performs median laparotomy, and then makes a unilateral A.-A. operation. The position of the uterus after the A.-A. operation is, however, not quite ideal, and the intraperitoneal shortening operations of the round ligaments of Deleri-Jilliam, Menge, Dartigue-Webster successfully replace the Alexander-Adams operation.