Modern surgery : General and operative / by John Chalmers Da Costa.

  • John Chalmers DaCosta
Date:
1900
Catalogue details

Licence: Public Domain Mark

Credit: Modern surgery : General and operative / by John Chalmers Da Costa. 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.

    981/1170 (page 963)
    duced. The value of partial nephrectomy in some cases seems certain, and we should apph* it when possible instead of the complete operation.^ Renipuncture.—This is an operation devised by Reginald Harrison for the relief of albuminuria due to elevated ten- sion. The kidney is exposed in the loin and the capsule is punctured or incised. Simple incision of the capsule will usually relieve nephralgia. Nephrorrhaphy (or nephropexy) is fixation of a mobile kidney. The kidney is exposed in the loin as above detailed, and is forced out of the wound by Edebohls's method. The fibrous capsule is incised longitudinally and a cuff is turned down on each side. Sutures traverse the kidney-substance and two layers of capsule on each side. The upper suture catches the periosteum of the last rib, the lower sutures catch the lumbar fascia. Drainage is not required. The suture-material is kangaroo-tendon or chromicized catgut. Kocher's incision is shown in Fig. 107. ]\Iany surgeons simply pass sutures through the uncut capsule and kidne}-- substance, and fasten the kidney to the lumbar fascia. Other surgeons split the capsule, pull it into the wound, and pass sutures through only the capsule and wound-edges. After nephrorrhaphy keep the patient in bed for three weeks. A kidney which has been anchored will not unusually loosen at some future time. Senn's Operation.—Man}- surgeons feel that it is not de- sirable to pass sutures through the kidney-substance. Urinary fistula has followed suturing. Again, the value of such sutures is very doubtful. The kidney is a very soft organ, and if it is suspended by sutures they are certain to cut out. Senn's operation fixes the kidne}- without using sutures. The kidney is held in place b}' an assistant. A vertical lumbar incision is made, the perirenal fat is exposed and is torn through until the kidney is reached. The kidne}- is usually brought out of the w-ound. The posterior fattv capsule is cut awa}-, and also the anterior capsule up to the hilum. The true capsule of the kidne}- is scarified, a long piece of iodoform gauze is placed under the upper end of the kidney, and another piece under the lower end. The kidney is replaced and will then lie in a sling, composed of two pieces of gauze, the ends of Avhich protrude from the wound. Gauze is packed into the opening over and about ^ See Oscar Bloch, in British Med. Jour., Oct. 17, 1S96; also, reports of Czemy, Bardenheuer, Tuffier, and Kiimmell.