Successful case of nephrorraphy for floating kidney. Uncompleted nephrectomy / by W.W. Keen.

  • Keen, William W. (William Williams), 1837-1932.
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Successful case of nephrorraphy for floating kidney. Uncompleted nephrectomy / by W.W. Keen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    important, to the aponeurosis which exists on each side of the in- cision. Finally, these stitches were not removed, but were left in situ. I believe with Svennson (Centralbl. f. Ohir., 1886, 824) that many failures have been due to employing absorbable catgut, to the avoid- ance of passing the stitches through the substance of the kidney, and to removal of the stitches, which in all cases I think should be left in, whatever the material employed. Svennson inserted as many as four- teen silk stitches, which were left in place and caused no trouble. The wound is best left to heal by granulation. I introduced a number of stitches to close the abdominal wall if necessary, but in twenty-four hours it was so filled up that it was evidently a needless precaution. The larger amount of cicatricial tissue that is pi'oduced by leaving the wound to heal by granulation probably fixes the kidney more firmly. Another very important point is, that the patient should liefl at on the back for at least a month after the operation, in order that the cicatricial tissue binding it in place may become thoroughly developed and firmly established. Even then, I would advise some support for the kidney in front by a pad or bandage, provided the patient bears it Avell. In this case I soon abandoned it, as it caused too much dis- comfort. It is to be noticed that though the stitches were passed through the kidney substance, the patient had no hematuria (this was carefully watched for) and that no inflammation or reaction seemed to follow. But seven weeks after the operation considerable pain devel- oped in the region of the kidney together with some albuminuria. This disappeared, however, after the use of Basham's mixture. The pain seemed to be rheumatic, and was soon relieved by the adminis- tration of salol.