The cure of the more difficult as well as the simpler inguinal ruptures.

  • Halsted, William, 1852-1922.
Date:
1903
Catalogue details

Licence: Public Domain Mark

Credit: The cure of the more difficult as well as the simpler inguinal ruptures. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    [310] anterior sheath of the rectus muscle might be employed in the way described whenever the conjoined tendon is insuffi- cient, whether the cremaster muscle can be well used to rem- edy the defect or not. And Berger' has recently suggested using the rectus sheath in much the same way in operations for the cure of inguino-interstitial hernia. In the upper part of the canal we have strong tissues and plenty with which to close, and hence it was perhaps natural to transplant the cord to the upper angle, to bring it out through thick muscle. But it is not perfectly certain that the cord may not be a useful adjunct in the closing or filling in of the lower angle in some cases, and it is a fact that with Bas- sini's operation the percentage of recurrence at the position of the transplanted cord in the case of adults has been quite large, probably over 6 per cent. Wliatever the truth may be, we have in the excision of the veins a distinct contraindication to transplanting the vas deferens, and thus far we have had no reason to believe that the results would have been better if the vas deferens had been transplanted, as was our custom for sev- eral years, to the outer angle of the canal. We may eventually discover that the transplantation of the cord, which Bassini, and at one time the author, considered not only so important, but perhaps the principal feature of the operation, is harm- ful rather than helpful. Briefly, we may find that not only the vas deferens, but even the entire cord, would be more safely transmitted at the lower angle of the deep wound than at the upper. It would require a very large number of observations to determine this point because the percentage of recurrences is so small in these days; and it is unfair to compare the results of various operations in the hands of various operators. Sur- geons do not seem to be agreed even as to what shall constitute a recurrence, or wound suppuration, and, if they were agreed, the personal element would still count for much. The Use of ihe Cremaster Muscle.—A device which we hit upon in our efTorts to close more securely the lower part of the ^P. Berger: La. Hernie ingiiino-interstielle et son traitement par la Cure radicale. Revue de Chirurgie, Janvier, 1902.