Having secured the pedicle we proceed to the investigation of the other ovary and the toilet of the peritoneum. The investigation of the remaining ovary is important for the reason that not infre quently a smaller cyst is found in it which will be readily overlooked and which will necessitate a subsequent op eration were this investigation omitted. Where a cyst of considerable size exists, the ovary should be removed. Smaller cysts in the ovarian diseased structure may be resected or the cysts may be punctured with a thermocautery. Where the ovary can be saved it should be done. We now proceed to the thorough investi gation of the peritoneal cavity, looking over the points at which separation has taken place, in order to make sure that no vessels of large size are bleeding. In stead of spending time, however, in sponging out the blood, the better plan of procedure is to irrigate the cavity with a large quantity of normal salt solution. If there are no bleeding vessels of size, the cavity may be filled up with this fluid and the wound closed. All bleed ing vessels, however, should be secured by ligature.
In operations on ovarian cysts and cystic ovaries any portion of ovarian tis sue which appears normal, even though small, should be retained; resection and plastic operations should be practiced on women when pregnancy is liable to occur, and delivery at term can be conducted with safety. In two cases of adherent and retroverted uterus with enlarged, prolapsed, and cystic ovaries, the cysts were excised from the glands, and the cut edges sutured with fine silk, the re sult in both being equally satisfactory. In one, a woman 35 years of age, there was disappearance of all pelvic symp toms; in the other menstruation fol lowed without pain or other morbid symptoms. J. C. Stinson (Occidental Med. Times, Oct., '97).
Pozzi regards retention of a certain portion of ovarian tissue as of great im portance, as in this way menstruation is often conserved. Indications for re section are found in benign cysts. In proliferating cysts there is danger of malignancy, and the clinical symptoms of malignancy should receive due weight. If both ovaries are affected and there is a probability of malignancy, total ex tirpation should be done. If the disease is malignant and confined to one side, the removal of ovaries is justifiable. In cases of chronic ovaritis the almost com plete integrity is a necessary condition in deciding on the preservation of the ovaries. Advanced sclerosis calls for complete removal. Partial operation is indicated in: (a) Follicular cysts of the ovaries. Provided that the tube is sound and that part of the ovary is healthy, resection of the cysts is sufficient, and part of the ovary may be left behind.
(b) Cysts of the corpus luteum. Their presence does not necessarily imply total degeneration of the organ, and as a rule preservation of a healthy portion is pos sible. (c) Sclerocystic or microeystic ovaritis characterized by the presence of numerous small cysts which exist inde pendently from lesions of the tubes. Hunter Robb (Cleveland Med. Gaz., Dec., '97).
Results of operations for malignant neoplasms of ovary at the Wilrzburg Clinic during seven years: 55 out of 239 cases of ovarian tumor, including papil lomatous cysts, were malignant. Of these, 23 were inoperable; 16 of the 32 in which an operation was performed were cancerous, S patients succumbing to the operation. Recurrence occurred in 3 instances, 20 per cent. of the patients being cured; SI.S per cent. of the cases of papill matous cyst had no recurrence, and 2 patients died. Total percentage of cures in all cases was 46.S per cent. Geyer (Inaug. Dis.; Centralb. f. Gynak., No. 32, '9S).
From study of many cases treated by the several methods of operation, the fol lowing conclusions are drawn: 1. That an irreparably damaged tube, ovary, etc., should be removed by enucleation, with ligation of vessels only, using only ab sorbable ligatures. 2. That enucleation is the simplest, safest, and most scien tific and esthetic method of removing an ovarian cyst, tumor, etc., of the ovary, the tube, the uterus, etc. There is no danger of if a vessel is severed it can be caught at once and ligated. J. Coplin Stinson (Canada Lan cet, Jan., '99).
In ovariotomy if the opposite ovary contains only a few retention-cysts it may be left after puncturing or resecting the cysts. If the cyst is of the true papil lomatous variety the other ovary should always be removed, even if it appears to be perfectly healthy, since experience has shown that it often undergoes papil lomatous degeneration afterward. This does not refer to' cases in which small excrescences are found in the inner walls of retention or parovarian cysts. Com mencing adenomatous degeneration of the opposite ovary may be suspected if the albuginea is much thickened and the organ is almost entirely transformed into large cysts with thick walls. In the case of young women a suspicious ovary may be split open, its interior examined, and, if healthy, may be sutured with cat gut. If one ovary is affected with car cinoma, sarcoma, or endothelioma, the opposite one should always be extir pated. Theilhaber (Brit. Med. Jour., Jan. 28, '99).