Tait Operation

TAIT OPERATION (Lawson Tait) belongs to the group of plastic operations used for the treatment of old, scarred perineal tears, predominantly of the second degree. Due to its simplicity of performance, it enjoyed great popularity in the 1890s. In its anatomical features, the operation differs significantly from the majority of operations proposed for the repair of perineal tears. The latter are based on the principle of removing scars present on the vaginal mucosa and perineal skin by freshening and excising flaps of mucosa and skin of various shapes; in Tait's technique, tissue is not removed, but is preserved entirely.

The author proceeded from the premise that in cicatricial perineal tears, in most cases, there is a deficiency or scarcity of tissue in general. By making a transverse incision through the scar, i.e., through the remnants of the perineum, and separating its edges, one penetrates into the loose cellular tissue of the rectovaginal septum; the edges of the wound then become mobile; the wound is sutured along the midline in a longitudinal direction. The shape and resistance of the perineum depend on the correct restoration of muscles and fasciae. That is why Tait did not attach importance to the shape of the incision of the vaginal mucosa and skin, correctly believing that the strength of the perineum depends not on the outer integuments, but on the nature of the arrangement of the muscles and fasciae within it and their correct joining by sutures.

The operation is performed as follows. After preliminary preparation of the external genitalia according to Grossich's method and protection of the operative field with sterile napkins on the perineal skin, in the region of the posterior commissure, Kocher clamps are applied at equal distances from the midline on each side; the latter are entrusted to assistants who stretch them in different directions; a lunate incision is made through the posterior commissure from one clamp to the other. The middle of the anterior edge of the incision is also grasped with a clamp and fixed with the left hand. The index finger of the right hand, wrapped in gauze, separates the flap of the vaginal mucosa upward. This tissue dissection is not always successful by blunt means; where there is much scar tissue or where the incision has not sufficiently penetrated into the cellular tissue, one has to resort to the help of scissors or a scalpel when moving the flap. When dissecting the flap, it is necessary to expose the deep muscles of the perineum (puborectalis muscle, levator ani muscle), for which purpose one should keep on each side lateral to the midline. The size of the dissected flap can be arbitrary; bleeding is insignificant, most often parenchymatous, and is stopped by gauze pressure. Deep sutures are placed on the cellular tissue of the rectovaginal septum, and subsequent sutures also capture the exposed muscle bundles of the pelvic floor (levator ani). The number of deep sutures varies depending on the size of the exposed area (3-5). The final purse-string suture is made along the free edge of the dissected mucosal flap, as a result of which the mucosa is gathered into a fold. Silk sutures or Michel clips are applied to the skin. The Tait operation gives a good immediate result; union of the surgical wound due to the absence of tension occurs well, and the same favorable result is observed in functional respects.

10. Gntolyeon.