From Big Medical Encyclopedia

COLPOTOMY (Greek kolpos a female bosom, a vagina + tome a section, a section) — a section of a wall of a vagina. Mean by the term «colpotomy» also a colpoceliotomy — a vulval chrevosecheniye. Distinguish a front and back colpotomy. To. is the initial stage front and back colporrhaphies (see), Manchester operation (see), Lefor's operations — Neygebauera (see. Lefora — Neygebauera operation ), vulval Cesarean section (see), hysterectomies (see), interpositions of a uterus (see). It is made at a kuldoskopiya (see. Peritoneoskopiya ), Kyustner's operations — Piccoli (see. Kyustnera — Piccoli operation ), for emptying of abscesses of a small pelvis.

Fig. The diagrammatic representation of some stages front and back a colpotomy at the left — options of cuts of a front wall of a vagina (1 — semi-lunar, 2 — oval, 3 — horseshoe, 4 — crosswise, 5 — median longitudinal); on the right — a cross section of the site of the back vault of the vagina covered with a peritoneum fixed by clips (the neck of uterus is taken away up).

In the presence of extensive commissural process in a small basin, in particular in rectouterine (duglasovy) space, at the big sizes of tumors of a uterus and appendages To. it is contraindicated.

At a lobby To. position of the patient typical for the majority of vulval operations. Operation is made under anesthetic or local anesthesia. After processing of external genitals and a vagina alcohol and iodine the neck of uterus is bared short and wide mirrors from three parties, taken bullet nippers and reduced. Then make a section of a front wall of a vagina: it can be semi-lunar, oval, horseshoe, crosswise, longitudinal median (fig.). In the acute and stupid way otslaivat a bladder up. At the same time it is necessary to aim to separate a fascia of a bladder from a neck of uterus. In process of separation from a neck of uterus the bladder is raised up the elevator. After full separation of a bladder from a neck of uterus bare a mobile whitish vesicouterine fold of a peritoneum. The peritoneum is opened between two tweezers. Then the wound is expanded in both parties then access to a uterus and appendages opens.

After operation the section of a vagina is sewn up tightly with catgut ligatures. Postoperative maintaining depends on the nature of the made operation.

At back To. between two clips open the site of a back vault of the vagina covered with a peritoneum (fig). At first cut a wall of a vagina, and then a peritoneum of rectouterine space. The operational wound is expanded in the parties, make the planned operation or manipulation then the wound of a vagina is sewn up tightly.

Emptying of abscesses of rectouterine space make by a section of a back vault of the vagina and a peritoneum, previously propunktirovav an abscess a thick needle. After suction of pus it is possible to enter a drainage rubber tube with a wide gleam into a wound, to-ruyu fix a thick silk ligature to small vulvar lips. (see. Douglas abscess , Duglasovo space ). The Kolpotomichesky opening begins to live without suture at daily washing of a vagina disinfecting solutions.

Bibliography: Braude I. L. Operational gynecology, M., 1959; Braude I. L. and Persianinov L. S. Acute management at obstetric and gynecologic pathology, M., 1962; Persianinov L. S. Operational gynecology, page 73, etc., M., 1976.

S. N. Kopshev.