The operative treatment of hernia by living sutures

Abstract

1.(1) A series of fifty patients with sixtythree hernias all operated upon by living suture method is reported from the Second Surgical (Cornell) Division of Bellevue Hospital.2.(2) The majority of these hernias were either direct, recurrent inguinal or ventral in type, and the age of this group averaged a decade above that of simple adult herniotomies.3.(3) The operation as performed by us is described in full with illustrations.4.(4) There were six recurrences in 34 traced hernias, the period of observation ranging from three to twenty-one months.5.(5) Postoperative wound infection was a complicating factor in 14 cases and was undoubtedly responsible for three of the recurrences, but did not seem to affect the end result in the other 11 cases. The presence of fascial sutures renders wound infection more likely to occur.6.(6) Barring wound infection, the postoperative course does not differ materially from that observed in simple herniotomy.Statistics show an apparent increase in mortality. Whether this would be maintained in a larger series of living suture operations is doubtful. Care should be taken in the selection of cases for this more prolonged operative procedure.7.(7) The operation is indicated in recurrent inguinal hernia, direct inguinal hernia, and large scrotal hernia associated with poor musculature. It is a valuable aid in dealing with postoperative ventral and large umbilical hernia. We regard it as a major procedure and reserve it for cases in which we feel it is distinctly indicated. The results of the operation should be judged with due consideration to the type of complicated hernia upon which it was used.