Fig. 615
Park’s method. Shoelace suture made with a sac split into two strips.
In these as in many other methods, much, practically everything, depends upon the certainty and durability of the sutures used for disposal of the inguinal canal. For some years surgeons used silver wire, which has now been abandoned. The choice now seems to depend on silk, thoroughly and freshly boiled, or animal sutures, such as kangaroo or reindeer tendon. McArthur suggested to dissect off a strip from the margin of the opening in the external oblique, or from the aponeurosis, and to use this strip of the patient’s own tissue for suture material. I have modified this method, as will be described later. Kocher devised a method of isolation of the sac, without such complete emptying of the inguinal canal, the sac being drawn up through the canal, then through the internal ring, and finally through an opening in the external oblique, over the internal ring, where it was twisted and fastened, after which the external portion was removed.
My own preference in operations for radical cure has been, until recently, an exposure similar to that of Bassini’s, with complete isolation of the sac, which is separated up to the level of the internal ring or even higher. At this point it is drawn out through an incision made in the external aponeurosis, twisted and fastened. The inguinal canal is then closed, its deeper layers by a shoelace suture of tendon, threaded into two stout curved needles, by which the deeper margins of the canal are brought accurately together. Sometimes I have transplanted the cord and again have dropped it back, the layer of shoelace sutures closing the external aponeurosis over it. It has not seemed to me to make any difference which method was adopted, and I have practically never seen any atrophy or permanent disturbance of the testicle.
More recently it has occurred to me to utilize the sac itself for suture material, and this is the method which I now adopt in those cases that permit of it.
[Figs. 613] to [616] show the method of thus utilizing the sac. A long thin sac may be twisted into a cord and used as an over-and-over suture, by which the margins of the canal are brought together. If found thick and unwieldy it may be trimmed down into a single suture, or it may be split, with more or less trimming, into two portions, by which the canal is then braided together or closed with a shoelace suture, the ends being tied or fastened at the lower portion. [Fig. 616] shows how a short sac not otherwise available can be lengthened and made sufficient for the purpose.
Fig. 616
Park’s method. A short sac is so divided as to be elongated sufficiently for use as a suture.