The prevention of hernia after incision of the abdominal walls / by George M. Edebohls.

  • Edebohls, George M. (George Michael), 1853-1908.
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: The prevention of hernia after incision of the abdominal walls / by George M. Edebohls. 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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    for January, 1893. r COMPLIMENTS UTHOR. Reprinted from The New York Journal of GyN/Ecology and Obstetrics THE PREVENTION OF HERNIA AFTER INCISION OF THE ABDOMINAL WALLS.1 By George M. Edebohls, A. M„ M. D. On June 27, 1891, I saw, with Drs. A. Freeh and C. Nicolai, her attendant physicians, a stout lady suffering for many years past from a large umbilical hernia. The hernia had become irreducible four or five days previously, symptoms of strangulation had manifested themselves, and the skin and fat overlying the hernial tumor were in a state of low phlegmonous inflammation. All attempts at reduction failed, the lady’s condition became critical and herniotomy was performed late at night on l June 29th, with the kind assistance of Drs. Freeh, Nicolai and Torek. After opening the sac it was found to contain the stomach, omentum and greater part of the small intestines, all adherent to each other and to the sac wall. After liberation of adhesions, reduction of the hernial contents, and ligation and removal of the sac, a large hernial aperture, circular in form, ten to twelve centimeters in diameter, with thin aponeu- rotic margins and situated in the median line just above the umbilicus, confronted us. The thin, sharp, fibrous margin was split all around by the knife to the depth of a little over a centimeter to obtain fresh sur- faces for union, and the margins of the ring were brought together by transverse sutures in such a manner as to form a longitudinal line of union when approximated. The intra-abdominal tension, however, was so great that it required all my strength, without exaggeration, to draw together and tie the sutures. I recognized that sutures embracing both the skin and the margins of the hernial aperture, if tight enough to close the latter, would inevitably strangulate the already inflamed skin and fat. Buried sutures to close the hernial aperture were a necessity. Catgut was tried, but the great tension opened the knots of the slippery material as fast as I could tie them. Interrupted sutures of heavy pedicle silk were used until my supply gave out, when I closed the balance of the aperture with interrupted silkworm-gut sutures. Ten silk and nine silkworm-gut sutures were thus placed and buried by closing over them, with catgut sutures, the skin and fat. The patient unexpectedly recovered from the operation, or rather from the condition which necessitated it, and still more unexpectedly was radi- ’Read before The New York Obstetrical Society, Nover&ber 15, 1892..