Gilliam-Doleri Operation

GILLIAM-DOLERI OPERATION (Gilliam, Doleris), is performed for incorrect positions of the uterus (retroversio, descensus et prolapsus uteri). Correction of the uterine position is achieved by shortening the round ligaments. Technique of the operation: a small incision is made in the middle of the abdomen through the abdominal wall, and the abdominal cavity is opened. Grasping the edge of the peritoneum and aponeurosis with Kocher clamps on one side, an opening is made in the lower half of the incision (2 cm from the edge) by the blunt method (using a closed Kocher clamp), passing through the aponeurosis, rectus muscle, and peritoneum. When the end of the Kocher clamp, having passed through the artificial canal thus created, appears on the side of the abdominal cavity, the clamp is opened and used to grasp the round ligament at a distance of 3-4 cm from the uterine angle. Upon retraction of the clamp, the round ligament is doubled up and appears as a loop above the aponeurosis (fig. 1 and 2). The same procedure is performed on the other side. The position of the uterus is corrected, and the body of the uterus is elevated, closely adhering to the abdominal wall. The peritoneum, muscles, and aponeurosis are sutured in layers, and the loops of the round ligaments, which until this moment had been held by Kocher clamps, are fixed to the aponeurosis with several sutures. For greater strength, the round ligaments can be additionally fixed to each other (fig. 3). Next, the skin incision is closed. Advantages of this operation: extreme simplicity of technique, sufficiently reliable results, and most importantly - preservation for the woman of the possibility of childbirth in the future. The latter advantage is a consequence of preserving the mobility of the uterus and its displacability due to fixation of the uterus only by the round ligaments.

Figure 1.

The abdominal cavity is opened. When the end of the Kocher clamp, having passed through the artificial canal thus created, appears on the side of the abdominal cavity, the clamp is opened and used to grasp the round ligament at a distance of 3-4 cm from the uterine angle. Upon retraction of the clamp, the round ligament is doubled up and appears as a loop above the aponeurosis (fig. 1 and 2). The same procedure is performed on the other side. The position of the uterus is corrected, and the body of the uterus is elevated, closely adhering to the abdominal wall. The peritoneum, muscles, and aponeurosis are sutured in layers, and the loops of the round ligaments, which until this moment had been held by Kocher clamps, are fixed to the aponeurosis with several sutures. For greater strength, the round ligaments can be additionally fixed to each other (fig. 3). Next, the skin incision is closed. Advantages of this operation: extreme simplicity of technique, sufficiently reliable results, and most importantly - preservation for the woman of the possibility of childbirth in the future. The latter advantage is a consequence of preserving the mobility of the uterus and its displacability due to fixation of the uterus only by the round ligaments.