Remarks on the modes of proceeding in regard to the hernial sac in th operation for strangulated hernia / by William Pirrie.

  • Pirrie, William, 1807-1882.
Date:
1848
Catalogue details

Licence: Public Domain Mark

Credit: Remarks on the modes of proceeding in regard to the hernial sac in th operation for strangulated hernia / by William Pirrie. Source: Wellcome Collection.

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    ON HERNIOTOMY. It is a question of great importance, in reference to the operation for strangulated hernia, which of the two following modes of pro¬ ceeding in regard to the hernial sac is the more advisable; namely, that of opening the sac, and dividing the stricture from within; or that of dividing the stricture, and replacing the parts without open¬ ing the sac. Of these two, technically called the mtra-peritoneal and extra-peritoneal modes of division, the former is that, which, except in a limited number of cases, has received the sanction and adoption of most surgical authorities in these islands. It appears certain that, in the great majority of cases, it is -by that mode alone, that it is possible to accomplish the two grand indications which it is desirable to fulfil by the operation; namely, the removal of the pressure by division of the stricture, and the return of the hernia. The fulfilment of the former, namely, the removal of the pressure by division of the stricture, is essential to the safety of the patient; and the latter, the return of the hernia, exceedingly desirable when practicable and proper. With regard to the first indication, when the stricture is exter¬ nal to the sac, as is not unusual, it is possible to divide it by adopting either mode; but if formed by the sac, or within it, it is clear, that by intra-peritoneal ‘division alone can the more impor¬ tant indication be fulfilled, or any good effected. Cases belonging to the latter class are by no means of unfrequent occurrence. That the neck of the hernial sac occasionally constitutes the stricture, is a point regarding which surgeons are agreed, instances having been recorded by the great surgical authorities of this and other countries, and examples occurring frequently in the practice of many surgeons. The sac, necessarily narrower at its neck than in other parts, is liable to be still further diminished by effusion and organization of lymph, either on its outer or inner surface, as well as by a thickened and