In other cases where a radical cure is necessary, because of adhesions within the hernial sac, the patients are similarly placed on their backs, the hernial sac is opened aseptically, the adherent parts liberated, the herniated portions of intestine reduced, and the hernial ring sutured with sterilised strong silk, the skin being afterwards brought together with silk sutures after removal of the sac itself. A surgical dressing can then be applied to the umbilicus. The patients should be carefully dieted.
When the hernial ring is large and its lips widely dilated, the silk sutures, even when supported by secondary sutures, sometimes cut through the tissues and do not achieve the desired result.
Fig. 222.—Schema illustrating Degive’s operation for umbilical and ventral herniæ. A, Serous; B, musculo-aponeurotic, and C, cutaneous coats of the hernia; D, the special needle in place; EE, clams; FF, nails. The three figures show the successive stages of the operation.
Degive’s method (see “Möller and Dollar’s Regional Surgery,” p. 304) can then be employed. The hernial sac is opened under antiseptic precautions, in order to break down any existing adhesions, and the skin and edges of the hernial ring are transfixed with packing needles about 8 inches long. Above these is adjusted a clam, which is closed, by means of a screw and firmly secured. The packing needles are then replaced with horse-shoe nails, the points of which are bent round. In about a week the necrotic tissue falls away, and recovery occurs even in severe cases in which previous treatment had failed.
ACQUIRED HERNIÆ.
Acquired or accidental herniæ are not serious, and only deserve to be studied in so far as they affect organs contained within the abdominal cavity. They may result from violence, or may occur without the intervention of any external cause.
Traumatic herniæ may occur at any point in the abdominal wall. Under the influence of a violent blow from a waggon pole, a horn thrust, a kick, a fall, etc., the muscular tunic of the abdominal wall is injured and becomes fissured in the direction of its fibres. The peritoneum is rarely affected. Being pushed outwards by the digestive viscera, however, the peritoneum projects into the muscular layer, distends it, separates the layers of subcutaneous tissue, and finally forms a distinct hernia.
The consequent disturbances are more or less marked and the lesions more or less variable, according to the part affected. In the lower region fissure of the abdominal wall affects the rectus abdominis, obliquus abdominis and transversus abdominis, and on the right side gives rise to hernia of the abomasum or small intestine, on the left of the rumen. In the lateral regions muscular fissures can be produced only in the transversus and obliquus abdominis muscles. Hernia of the rumen is rare on the left side. On the right side hernia of the intestine is more readily produced.
In all cases where hernia is suspected, the hernial orifice should be examined. Its situation will at once show which organ is affected.