Hysterocleisis

HYSTEROCLEISIS (from the Greek hystera- uterus and cleisis- closure), an operation involving the suturing of the anterior and posterior lips of the cervix. It is used in vesicocervical fistulas. The same name is given to the operation used for high, extensive vesicovaginal fistulas, which consists of suturing the posterior lip of the cervix or part of the posterior fornix, after freshening the edges, to the lower edge of the fistula (hysterocleisis vesicalis). H. was applied in cases where ordinary suturing did not give success. After the operation, although constant leakage of urine ceases, on the other hand, the woman becomes infertile, uterine secretions and menstrual blood pass through the bladder, which leads to the development of severe ascending infection. At present, there are operative methods (plastic, transvesical, intraperitoneal) which successfully replace this palliative and unpleasant in its consequences operation. Finally, in severe cases, removal of the uterus should be preferred, which facilitates easier suturing of the fistula.

Figure 9. Removal of the uterus per vaginam; the lower part of the base of the broad ligament has already been ligated and severed; the next part is being ligated.

Vesicouterine fistula; the mucous membrane of the external os of the uterus and its cervical canal has been removed; the vitalized surface is marked with a zigzag line; one suture has been applied.

Vesicouterine fistula; the mucous membrane of the external os of the uterus and its cervical canal has been removed; the vitalized surface is marked with a zigzag line; one suture has been applied.

In severe cases, removal of the uterus should be preferred, which facilitates easier suturing of the fistula.