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Summary Experience with absorbable gauze during the past ten months has shown that it was frequently useful in controlling bleeding during abdominal gynecologic operations. It should in no sense replace the careful control of hemor rhage by clamp and ligature. However, when bleeding was difficult to control by such methods, either because of its oozing character or because the source of hemorrhage was not readily accessible, absorbable gauze was found to have a, definite place as a hemostatic agent. Its application to the area of bleeding followed by momentary digital pressure was successful in most instances. When, in a few cases, hemorrhage recurred following the removal of digital pressure, satisfactory results were attained by superimposing ordinary packing. The latter material was removed in twenty-four hours with evidence of a minimal amount of bleeding in the interim, and no recurrence of bleeding following its removal. The early complete removal of plain packing without fear of provoking fresh hemorrhage was a great advantage. No reaction could be traced to the leaving of varying amounts of oxidized gauze within the abdominal or pelvic cavities. A few unusual applications of it during abdominal operations have been mentioned. Undoubtedly others will occur as experience in the application of this material grows. Absorbable gauze also proved to be of value during vaginal procedures. As has been pointed out, it sometimes proved to be ineffective when applied to the oozing incision of completed plastic operations. Its inability to control such bleeding cannot be regarded as a failure, but as a faulty application. The gauze must be placed in direct contact with the bleeding vessels under temporaxy or permanent pressure to cause hemostasis. On the other hand, absorbable gauze was used effectively during the course of a plastic operation to check oozing not readily controlled by ligature. It was effective in controlling hemorrhage from biopsy wounds and from the crater of a carcinomatous cervix. The most valuable application of this material noted in this series of cases was in a group exhibiting violent secondary hemorrhage some days after a, plastic operation, a cervical amputation, or a complete hysterectomy. Absorbable gauze placed against the source of hemorrhage and held in position with plain packing promptly controlled such hemorrhage. Formerly plain packing usually proved ineffective Trader such circumstances, necessitating ligation of bleeding vessels and resuture of the disrupted area under conditions of difficult exposure. The use of absorbable gauze in such cases appeared to offer great advantages.

A total of 185 cases were reviewed of major gynecologic surgery performed upon women 65 years of age and older from 1970 to 1973 at a 350 bed community hospital. Each private staff physician operated upon his private patient. There were 112 vaginal operations performed, mostly for pelvic relaxation problems, and 73 abdominal operations. Forty-two patients had surgery for cancer. There were nine postoperative complications and only two deaths. It can be concluded from this study that the elderly female can tolerate major gynecologic surgery very well in a modern-day hospital setting.

1. 1. During the past century a surprisingly large number of abdominal operations for the correction of uterine displacements have been proposed, devised, and practiced. 2. 2. Since it is imperative that certain definite conditions be fulfilled by all surgical procedures for the relief of retroversion and prolapse, the majority of operations offered to the profession have fallen by the wayside, while only a comparatively few have survived. 3. 3. One of the most popular and successful of techniques, and one which has enjoyed fifty years of acceptance, is the Webster-Baldy operation. It embodies certain admirable physical principles, corrects the existing malposition, but unfortunately possesses a few very objectionable features. 4. 4. A modification of this procedure has therefore been evolved, by means of which its desirable aspects are retained, and its disadvantages simultaneously obviated.