[What about partial subcutaneous symphysiotomy or Zarate's operation? Review of the literature]

This study is a review of the literature on Zarate's partial subcutaneous symphysiotomy. Unfortunately, this operation is now forgotten since many obstetricians in western countries and even those of developing countries feel that symphysiotomy is an obsolete obstetric procedure. Partial subcutaneous symphysiotomy is an operation intended to widen the maternal pelvis in order to enable vaginal delivery in the presence of moderate feto-pelvic disproportion. The procedure, which requires only a urinary catheter, a scalpel and local anesthesia, consists of division of the anterior ligament of the public symphysis and part of the inferior ligament (arcuate ligament of the pelvis), while leaving intact the superior ligament or "anatomo-surgical restraint" of Zarate, ensuring limitation of pelvic spread. Symphysiotomy has currently been abandoned by all or almost all teams because of its alleged maternal and fetal morbidity and mortality. We feel, however, that in certain rural areas of third world countries, often ill-equipped and with poor medical services, this procedure can still be very useful in certain exceptional situations in dystocia by moderate feto-pelvic disproportion, in circumstances in which cesarean section is impossible. The experience of the rare teams still using symphysiotomy shows that a degree of disdain is legitimate in face of the ominous reservations expressed as to the possible complications of this procedure.