1Single Surgical Procedures in Obstetrics and Gynaecology–04 A Colour Atlas of Complete Perineal Tear2
3Single Surgical Procedures in Obstetrics and Gynaecology–04 A Colour Atlas of Complete Perineal Tear
Series Editors Arun Nagrath MS MAMS FICOG
Professor and Head Department of Obstetrics and Gynaecology Rural Institute of Medical Sciences and Research,
Saifai, Etawah, Uttar Pradesh, India
Erstwhile Professor and Head Department of Obstetrics and Gynaecology SN Medical College,
Agra, Uttar Pradesh, India
Senior Clinical Training Consultant Johns Hopkins Program for International Education in Gynaecology and Obstetrics (JHPIEGO),
Baltimore, USA
Narendra Malhotra MD FICOG FICMCH
President, FOGSI 2008 Dean, ICMU 2008-2009 Director, Ian Donald School of Ultrasound Consultant and Director Malhotra Nursing and Maternity Home (P) Ltd., Agra, Uttar Pradesh, India Apollo Pankaj Hospital (P) Ltd.,
Agra, Uttar Pradesh, India
Associate Editor Rajani Rawat MS
Assistant Professor Department of Obstetrics and Gynaecology Rural Institute of Medical Sciences and Research,
Saifai, Etawah, Uttar Pradesh, India
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Single Surgical Procedures in Obstetrics and Gynaecology–04: A Colour Atlas of Complete Perineal Tear
First Edition: 2013
9789350255742
Printed at
5Dedication
One of the legendry artists’ surgeons of India who excelled and afforded respect to a newly formed specialisation Gynaecological and Obstetrical Surgeries.
Famous in the 50s, 60s and 70s fondly called Teacher of Teachers.
Through this great master, I see a glimpse of his surgical mannerisms in my work trying to achieve surgical perfection which came so naturally to him.
Lest he be forgotten in the footprints of time, a humble effort to propagate his excellence through this organisation for posterity.
… lest the coming generations be starved of the magical art of gynaecological and obstetrical surgery.
7Preface
Anything that simplifies our medical education and practice has always been welcomed. This series, “Single Surgical Procedures in Obstetrics and Gynaecology” is organised into multiple volumes on all gynaecological and obstetrical surgical procedures related to the female genital organs. Special sections are dedicated to patient positioning, type of incision, their closures along with proper use of drains, suture choices, etc.
There should be no place for a Complete Perineal Tear, which can be considered as an unwelcome outcome, in modern obstetrical practice. Horrifying though it may appear, domiciliary midwifery is still rampant in the subcontinent and the resulting complications are encountered in plenty. Even more distressing is the observation that these cases with complete perineal tears are forced to live with this perpetual incontinence for many decades for want of proper medical attention before they finally reach a tertiary centre where perineal plastic repair facilities are available.
We as editors of this Colour Atlas of Gynaecologic Single Surgical Procedures in Obstetrics and Gynaecology have set out to simplify surgical repair of complete perineal tears by creating a step-by-step procedural process, illustrated to emphasise those surgical steps, which are critical to this procedure. We have also provided important notes in an effort to aid the surgeon in reducing blood loss, minimising complication rates and improving their surgical skills.
All the commonly done obstetrical and gynaecological procedures are illustrated in this series. Nevertheless, some rarely done procedures required by very selected group of cases are also discussed in different volumes so that one can assist the experienced surgeon, with this book serving as a source of basic information illustrating the surgical technique.
We hope that the resident gynaecologic surgeon will find this series of books on surgical procedures very useful as he or she prepares for a career in this area of medicine and begins to perform these procedures.
We believe that the experienced gynaecologic surgeon will also find this a useful reference guide with many new approaches and helpful notes for commonly performed operations.
Arun Nagrath
Narendra Malhotra
9Acknowledgements
We are grateful to Director, Brig T Prabhakar, who has a fixation for quality and continued progress, dedicated to his institution. He has always cajoled his staff to move forwards and do something that “makes a difference”. Though he is not heading the institution today, his infectious zeal of toil and excellence continues to inspire us.
This book is an attempt in this direction. All through our hours of toil he always helped us in smoothening the rough edges and this work carries the hallmark of his “quality”.
We are thankful to all the staff of the Department of Obstetrics and Gynaecology of UP Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India for their contribution in this project.
My better half, Dr (Mrs) Manju Nagrath, Department of Radiodiagnosis, UP Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India, who has stood by me, tolerating my hours of frustration and its manifestations and constantly encouraging me to “keep up” my endeavours and see this work through completion. A gynaecologist herself, she has always been by my side helping me at every step through the completion of this volume.
The preparation of the book of this magnitude involves many individuals who play an important role in its creation. We are especially proud of the quality of the photographs and it would be in place to put on record the contribution of Mrs Geeta Jha, nursing sister in charge, who has shouldered the additional responsibility of helping us in the photography apart from providing facilities in the “State of Art” operation theatre in the Department of Obstetrics and Gynaecology, UP Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, India.
To my patients who have very kindly consented to allow the use of their operative sequences for the purpose of advancement of medical education.
Arun Nagrath
Narendra Malhotra
11All Volumes in the Series “Single Surgical Procedures in Obstetrics and Gynaecology”
This book is one of the titles in the series of Single Surgical Procedures in Obstetrics and Gynaecology, a series which will eventually have 36 volumes.
If you wish to be kept informed of new additions to the series and receive details of our other titles, please write to Jaypee Brothers Medical Publishers (P) Ltd at sujatha.jp@gmail.com.
We list below a few of the other titles in print and in preparation in the Single Surgical Procedures series. Titles already published are marked (*); those titles to be published during the coming months are marked (#).
VULVA – A
*VOL-1 | Bartholin's gland excision |
Marsupilisation of Bartholin cyst | |
Release of labial fusion | |
VOL-2 | Hymenectomy (Imperforate hymen) |
Simple vulvectomy |
VAGINA – B
VOL-3 | Anterior colporrhaphy and Kelly's plication |
Posterior colpoperineorrhaphy | |
Vaginal repair of enterocoel | |
Abdominal repair of enterocoel | |
*VOL-4 | Complete perineal tear repair |
VOL-5 | Fenton's operation |
Episiotomy | |
Schuchardt's operation |
CERVIX – C
VOL-6 | Biopsy of cervix |
Cervical conisation | |
Endocervical curettage at colposcopy | |
Conisation of cervix by LEEP | |
Electrocauterisation of cervix | |
Cervical cryocauterisation | |
VOL-7 | Trachelorrhaphy |
Abdominal excision of cervical stump | |
VOL-8 | Correction of incompetent cervix by Shirodkar's technique |
Correction of incompetent cervix by | |
McDonald's operation | |
Correction of incompetent cervix by | |
Lash operation |
UTERUS: ABDOMINAL HYSTERECTOMY-D1
VOL-9 | Total abdominal hysterectomy |
Total abdominal hysterectomy with bilateral salpingo-oophorectomy | |
Nagrath's minilap hysterectomy | |
VOL-10 | Abdominal subtotal hysterectomy |
Obstetrical hysterectomy |
UTERUS: VAGINAL HYSTERECTOMY-D2
VOL-11 | NDVH - Conventional approach |
NDVH - With salpingo-oophorectomy | |
NDVH - Debulking by uterine bisection | |
NDVH - Debulking by wedge excision | |
NDVH - Debulking by myomectomy | |
NDVH - Debulking by morcellation | |
NDVH - Debulking by Coring | |
NDVH - Debulking by spiral incision | |
NDVH - Debulking by cervical amputation | |
NDVH - Debulking by cervical wedge | |
*VOL-12 | Ward Mayo's hysterectomy |
Modified Ward Mayo's hysterectomy— | |
Dr Nagrath's modification | |
Clampless vaginal hysterectomy |
UTERUS-D3
VOL-13 | Dilatation and curettage |
Suction curettage for abortion | |
Dilatation and endometrial biopsy | |
Fractional curettage | |
*VOL-14 | Upper segment caesarean section |
Lower segment caesarean section |
UTERUS: DISPLACEMENTS-D4
*VOL-15 | Cervicopexy (Purandare's) |
*VOL-16 | Supravaginal cervical amputation (Nadkarni's) |
VOL-17 | Manchester's operation |
Fothergill's repair | |
VOL-18 | Shirodkar's anterior sling |
Shirodkar's posterior sling | |
VOL-19 | LeFort's operation |
Gilliam's operation | |
Modified Gilliam's operation | |
William Richardson's operation | |
*VOL-20 | Ventral suspension of vaginal vault |
Abdominal sacro-colpopexy |
VOL- 21 | Myomectomy for Fundal fibroid, Hood's operation |
Myomectomy for anterior wall fibroid | |
Myomectomy for isthmic fibroid | |
Myomectomy for anterior cervical fibroid | |
Myomectomy for posterior wall fibroid | |
Myomectomy for intracavitary fibroid | |
Myomectomy for fibroid polyp | |
Myomectomy for broad ligament fibroid | |
Myomectomy for round ligament fibroid | |
Myomectomy for multiple fibroids |
FALLOPIAN TUBES AND OVARIES-E1
VOL-22 | Salpingo-oophorectomy |
Wedge resection of ovary | |
Ovarian cystectomy | |
Ovariotomy | |
VOL-23 | Enucleation of broad ligament cyst |
Ectopic pregnancy |
FALLOPIAN TUBE RECONSTRUCTION-E2
VOL-24 | Salpingolysis |
Fimbriolysis | |
Salpingo-ovariolysis | |
Salpingostomy | |
Salpingectomy | |
VOL-25 | Cornual reimplantation |
Fimbrioplasty | |
Tuboplasty—Microresection and anastomosis |
FEMALE STERILISATION-E3
VOL-26 | Laparoscopic sterilisation by silastic bands |
Sterilisation by minilaparotomy technique | |
Sterilisation by Pomeroy's operation | |
Sterilisation by modified Pomeroy's operation | |
Sterilisation by Irving's method | |
Sterilisation by Uchida's method | |
Sterilisation by Madlener's method | |
Sterilisation by Parkland's method | |
Sterilisation by Aldridge method | |
Sterilisation by Kroener's method | |
Sterilisation by Oxford's method | |
Sterilisation by Shirodkar's method | |
Fimbriectomy |
ABDOMINAL WALL-F
*VOL-27 | Infra-umbilical midline laparotomy |
Paramedian abdominal incision | |
Pfannenstiel's incision | |
Kustner's incision | |
Maylard's incision | |
Cherney's incision | |
VOL-28 | Abdominal closure |
Single layer abdominal closure | |
Skin closure methods | |
Use of drains | |
Incisional hernia repair |
URINARY STRESS INCONTINENCE-G
VOL-29 | Retropubic urethropexy |
Kelly's operation | |
Marshall Marchetti Krantz operation | |
Burch suspension operation |
CONGENITAL ANOMALIES-HI
VOL-30 | Strassmenn's utriculoplasty |
Jone's utriculoplasty | |
Tompkin's utriculoplasty | |
*VOL-31 | Excision of transverse vaginal septum |
Excision of longitudinal vaginal septum | |
VOL-32 | Mc Indoe's vaginoplasty |
Modified McIndoe's vaginoplasty | |
William's vulvo-vaginoplasty | |
#VOL-33 | Ileal neovagina |
FISTULA OPERATIONS
#VOL-34 | Layer method of RVF |
Sim's Moir saucerisation | |
Latzko's operation | |
VOL-35 | Urethral reconstruction |
Vesicovaginal fistula | |
Vesicocervical fistula | |
Ureterivaginal fistula |
MISCELLANEOUS OPERATIONS-J
VOL-36 | Intestinal loop urinary diversion |
Urinary diversion cutaneous ureterostomy | |
Urinary diversion uretero-sigmodostomy | |
Ureterovesicle anastomosis (psoas hitch) | |
Posterior colpotomy | |
Insertion of suprapubic catheter | |
Demonstration of tubal patency via laparoscopy | |
Demonstration of tubal patency by HSG |