Notes on the radical cure of hernia / by W. Mitchell Banks.

  • Banks, W. Mitchell (William Mitchell), 1842-1904.
Date:
1884
Catalogue details

Licence: Public Domain Mark

Credit: Notes on the radical cure of hernia / by W. Mitchell Banks. 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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    should, if possible, be broken down, as, if this is not done, the omentum stump remains fixed to the abdominal wall at the inner opening of the ring or even in the canal, and so remains as a persistent guide for something more to come down in its track. The omentum stump should be cut quite adrift from the abdominal wall, and when pushed up should tumble loose into the abdominal cavity. As far as I can see it does not matter how tight the ligatures are tied:—the tighter the better. Only the omentum should not be cut off too close to the ligature, lest it slip. A good large stump should be left for safety’s sake. In splitting the omentum up to allow of several ligatures being put on, too great care can hardly be exercised not to split up a big omental vein. These veins are excessively thin, and a very little pressure empties them. An empty one can be quite easily torn longitu- dinally, and then, as one side goes to each tied-up pedicle, it is kept permanently open, and when the stump is returned, and all pressure taken off, it bleeds furiously. This very accident once happened to me, and gave me a very great fright. The patient, Edward Hancox, aged 41, was admitted with a strangulated inguinal hernia, upon which I proceeded to operate. Having dissected out the sac, I opened it, divided the stricture, and reduced the gut. There remained a considerable mass of adherent omentum, which I split into three pieces with my fingers, and having tied each piece with catgut, I cut off the mass and restored the stump into the abdomen. No sooner was this done than venous blood began to pour out of the external ring. Thinking my incision for dividing the stricture had cut some abnormal vessel, I slit up the neck of the sac and the external ring, and saw the nick I had made, from which no blood was coming. The bleeding evidently came from the abdominal cavity, as was shown by the fact that when a coil of bowel came down and plugged up the inguiual ring it stopped, but the minute this coil was pushed up by the finger the blood gushed out again. It was clear that the bleeding could only come from the stump of the omentum, which had been returned into the abdominal cavity, and that this must be found at all hazards. So I ripped up the inguinal canal, and then the abdominal wall along the outer edge of the rectus