Clean cases of strangulation may be closed without drainage. In case of doubt, however, it is advisable to provide at least a capillary drain, while every case known to have been contaminated should be perfectly drained.
Fig. 611
Bassini’s operation. Ligation of the sac by means of a purse-string suture passed through the internal surface of its neck. The cord is drawn to one side. The aponeurosis of the external oblique is drawn apart with forceps. (Richardson.)
Fig. 612
Bassini’s operation. Suture of the conjoined tendon to the internal surface of Poupart’s ligament. Fortification of the posterior surface of the canal. (Richardson.)
Radical Cure of Hernia.
—From the earliest times rude and crude methods of endeavoring to effect a radical cure of hernia have been in vogue. While sometimes effective they have always been dangerous and always clumsy. Not until the antiseptic method was introduced could they be regarded as in any way safe or reliable. With the introduction of Listerism it became practicable to do this work, upon principles simple in character and ordinarily easy of performance, which may be summed up in the formula: Isolation and obliteration of the hernial sac, with permanent closure of the hernial outlet. Easy as such description may sound it has been found more or less difficult in practice, and numerous methods, apparently both simple and ingenious, have proved defective and have called for the most pronounced modification. Considerable space could be devoted to operations for radical cure, but the intent here shall be to simplify the subject as well as the method, and consequently but two or three will be described. Suffice it to say that while all are based on the same principle they vary somewhat in detail, and that some of these details have to be adapted to the special requirements of individual cases.
With increase in experience has come enlarged confidence in the operation, and it is now regarded as justifiable in nearly every instance among individuals otherwise in good condition. It has a double purpose—namely, the avoidance of the danger of sudden strangulation and the riddance of necessity for wearing trusses, or suffering the discomforts of hernia without any mechanical control. Some modern methods include the utilization of some portion or all of the sac, while in others it is entirely cut away. Consequently some operators have endeavored to utilize such portion of the sac as could be made available for either purpose, either as plug or suture material.