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DZHILYAMA-DOLERI OPERATION (D. T. Gilliam, amer. gynecologist, 1844 — 1923; J. A. Doleris, the fr. gynecologist, 1852 — 1938) — the operation improving situation uterus by its suspension to a front abdominal wall on the shortened round ligaments of a uterus with fixing of their loops over an aponeurosis. In 1898 Mr. of Doleri offered operation of a metrorthosis by fixing of loops of round ligaments of uterus over direct muscles of a stomach. Dzhilyam in 1900 altered a technique of operation, fixing loops of round ligaments of uterus over an aponeurosis. In 1904 Bardesku, besides, recommended to sew loops of round ligaments of uterus over an aponeurosis among themselves (fig.). In 1922 V. Kiparsky offered the modification of operation: to hem the distal ends of round ligaments of uterus to a front surface of a uterus.

Indication to D. — D. of the lake is the wrong position of a uterus (the retroversion — an inflection, omission and a prolapse of the uterus).

Technology of operation (with Kiparsky's modification)

the Diagrammatic representation of operation of Dzhilyam — Doleri in Bardesku's modification: duplikatura of round ligaments of uterus (1) are carried out through an opening (2) in a peritoneum and an aponeurosis and fixed to its outer surface; in abdominal section are visible: uterus (3), uterine tubes (4) and ovaries (5); on the right above — the final stage of operation — duplikatura are connected among themselves.

2 — 3 cm above bosoms on the centerline make a section of a front abdominal wall 8 — 10 cm long (fig). The front surface of a vagina of direct muscles of a stomach in both parties from a section is exempted from a fatty tissue. 5 cm higher than the upper edge of a bosom and on 2 cm from midsection do in an aponeurosis from that and other party of an opening 1 — 2 cm long. Through these cuts pierce with a soft clip direct muscles of a stomach and a peritoneum. Take round ligaments of a uterus in an average third, their distal ends hem to a front surface of a uterus slightly below than the place of an otkhozhdeniye of round sheaves. The formed loops of round sheaves remove over an aponeurosis then sew up with a continuous catgut suture a peritoneum and direct muscles of a stomach, on an aponeurosis put separate knotty stitches. The loops of round ligaments of uterus removed over an aponeurosis connect among themselves a thin silk seam and fix them to an aponeurosis several silk seams. It is necessary to stitch round ligaments of a uterus at the same time no more than on one third of thickness not to break their food. Then sew up a hypodermic fatty tissue and skin.

To possible to complications infringement of loops of intestines in vesicouterine deepening, a necrosis of round ligaments of uterus owing to disturbance of their food belongs.

— D. of the lake is applied seldom in connection with a frequent recurrence of a disease since thin and hyperinflate round sheaves cannot hold a long time a uterus in the correct situation.

Bibliography: Braude I. L. Operational gynecology, page 299, M., 1959; The Multivolume guide to obstetrics and gynecology, under the editorship of L. S. Persianinov, t. 6, book 2, page 515, M., 1961; Persianinov L. S. Operational gynecology, M., 1976; Doleris A. Raccourcissement des ligaments ronds, Gaz. Hop. (Paris), t. 62, p. 70, 1889; o h, Traitement chirurgical de la retroversion (resultats de 88 cas) trai-tes par le raccourcissement des ligaments ronds combine aux operations plastiques sur le col, le vagin, le perinee..., Gynecologic, t. 3, p. 17, 1898; GilliamD. T. The Gilliam operation for deviation of the uterus, Int. J. Surg., v. 19, p. 380, 1906.

V. M. Utkin.