Baldy-webster suspension

Baldy-webster suspension

Although the surgeon would in all probability not select the Baldy-Webster type of uterine suspension as a sole definitive procedure in the rare instances when such a suspension might be indicated, nevertheless it does have a useful place in pelvic surgery.

The procedure is most useful when in the course of a conservative operation for endometriosis or pelvic inflammation the peritoneum of the broad ligament or posterior serosal surface of the uterus has been either sacrificed or traumatized. In this situation it is often difficult to mobilize enough peritoneum to cover the defect. It is also of value to cover the suture line of a posterior uterine wall myomectomy.

When the original disorder has been endometriosis the surgeon may want to maintain the uterus in forward position and may not be enthusiastic about peri – tonealizing the defect with either the sigmoid or a free omental graft. It is a relatively easy operation to bring the round ligaments through the posterior leaf of the broad ligament and suture this to the back wall of the uterus. The round ligaments can then be covered by mobilizing peritoneum. This is the Baldy-Webster suspension.

Figure 1. The uterus is placed on forward traction to expose the posterior leaf of the broad ligament. A bloodless area beneath the ovarian ligament is thus exposed. The assistant aids in the exposure by retracting the tube and ovary with a Babcock forceps. The surgeon picks up the peritoneum and incises it in the bloodless area with curved scissors.

Figure 2. The assistant retracts the adnexa while the surgeon inserts a Kelly clamp through the opening in the posterior leaf of the broad ligament and incises the anterior surface of the broad ligament between the open jaws of the clamp.

Figure 3. The opening in the posterior broad ligament is enlarged with curved scissors.

Figure 4. The assistant continues to hold back the tube and ovary while the surgeon pulls the uterus to the left. The surgeon inserts an Allis forceps through the opening in the broad ligament and grasps the round ligament at a point well away from the uterus.

Figure 5. A loop of the round ligament is pulled through the opening in the two leaves of the broad ligament onto the posterior wall of the uterus.

Figure 6. The assistant retracts the adnexa and uterus as the round ligament is approximated to the posterior uterine wall with interrupted sutures. A point midway between the fundus and cervix just lateral to the midline’is the ideal position.

Figure 7. The same procedure is carried out on the left side. The defect in the posterior wall of the broad ligament must be closed to prevent herniation of small bowel through the opening. The surgeon places interrupted catgut sutures through the peritoneum lateral to the cut edge and secures it to the peritoneal surface of the uterus.

Figure 8. This shows the completed suspension and peritonealization. The uterus should lie easily, without angulation.

Conservative operations baldy-webster suspension

Baldy-webster suspension

Baldy-webster suspension

Baldy-webster suspension

 

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