War Surgery and Medicine
In the Middle East Force the question of the frequency of recurrence caused much comment at one time, and investigations were carried out to find the cause. It was considered that unsatisfactory operative technique had been responsible for some of the recurrences.
It was ascertained that many of the recurrences were due to the inability to remove the sac satisfactorily, and in some cases the original sac was intact, and there was dissatisfaction with the Bassini and similar techniques.
There was a tendency to rely on the simple removal of the sac and not to interfere with the normal functioning of the musculature of the inguinal canal. It was emphasized, however, that operative repair of inguinal hernia was not always an easy matter to be delegated to the young untrained surgeon, but that it was highly important that the first operation performed be carried out with great care by a surgeon of experience who could add, as necessary for the individual case, some extra form of plastic repair, as little damaging as possible to the functioning musculature of the inguinal canal. The problem, fortunately, did not apply so much to 2 NZEF, in which there were comparatively few recurrences. Two reviews of the cases in the 2 NZEF were made by the consultant surgeon, one in May 1942 and the other in March 1943.
By May 1942 there had been 228 operations for primary hernia with two recurrences, one a sliding hernia on the right side and the other following a post-operative chest complication associated with a cough. There were five recurrences following pre-war operations performed in New Zealand. Six cases had had one recurrence and one case had had two recurrences on one side.
By March 1943 there had been a total of 361 operations for inguinal hernia in the following categories:
|Inguinal Hernia: Indirect or unspecified||330|
|Inguinal Hernia: Direct||10|
|Inguinal Hernia: Fascial repair||2|
|Inguinal Hernia: Recurrent||19|
It was noted that cases operated on for recurrence were very liable to break down again, thus denoting a marked weakness of page 413 the abdominal musculature. For instance, one case had an operation for bilateral hernia in 2 NZEF with a history of Battle's incision eighteen years previously and a right hernia operation eleven years previously. Operation on the right side for recurrence took place in April and September 1942, the last being a repair by silk which was effective; there was still a slight recurrence on the left side.