Gilliam-Doleris Operation

GILLIAM-DOLERIS OPERATION (Gilliam, Doleris), performed for abnormal positions of the uterus (retroversio, descensus et prolapsus uteri). Correction of the uterine position is achieved by shortening the round ligaments. Surgical technique: a small incision of the abdominal wall is made along the midline of the abdomen, and the abdominal cavity is opened. Grasping the edge of the peritoneum and aponeurosis on one side with Kocher clamps, an opening is made in the lower half of the incision (stepping back 2 cm from the edge) by blunt dissection (using a closed Kocher clamp) passing through the aponeurosis, rectus muscle, and peritoneum. When the end of the Kocher clamp, having passed through the artificial canal thus created, appears from the side of

Figure 1.

the abdominal cavity, the clamp is opened and used to grasp the round ligament at a distance of 3-4 cm from the uterine angle. Upon withdrawing the clamp, the round ligament forms a duplication and appears as a loop above the aponeurosis (figures 1 and 2). The same procedure is performed on the other side. The position of the uterus is corrected, and the uterine body is elevated, closely adhering to the abdominal wall. The peritoneum, muscles, and aponeurosis are sutured in layers, and the loops of the round ligaments, which up to this moment were held by Kocher clamps, are fixed with several sutures to the aponeurosis. For greater strength, the round ligaments can be additionally fixed to each other (figure 3). Next, the skin incision is closed. Advantages of this operation: extreme simplicity of technique, fairly reliable results, and most importantly, the preservation of the possibility of childbearing for the woman in the future. The latter advantage is a consequence of preserving the mobility of the uterus and its displacement capacity due to the fixation of the uterus solely by the round ligaments.