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War Surgery and Medicine

Operative Treatment in 2 NZEF

Operative Treatment in 2 NZEF

This was carried out in the New Zealand base hospitals by any of the surgeons available. When the hospitals were fully occupied with battle casualties, the hernia cases were deferred, both from the point of view of space, and also of possible infection. With the large numbers of surgeons concerned there was no uniformity of operative technique, but the following four main types of operation were carried out:

Simple removal of the sac without any alteration in the ordinary anatomy of the inguinal canal. This technique was favoured in the early case of indirect hernia in young men, where no undue weakening of the musculature and fascial layers had taken place.

Removal of the sac and in addition some reinforcement, its form depending on the case and on the surgeon, by repairs of the Bassini type, by suturing of the transversalis fascia, especially round the internal ring, by suturing the conjoint tendon to Cooper's ligament, by overlapping the external oblique aponeurosis, by utilising a flap from the rectus sheath to suture to Poupart's ligament, all methods to strengthen the wall of the inguinal canal, either with or without displacement of the cord.

Silk Repair: The utilisation of strong silk to lace up the posterior wall of the inguinal canal, and especially the region of the internal abdominal ring, was much in vogue at the beginning of the war, as a simpler and just as efficient method as that of the utilisation of fascial strips. The method was recommended by Major-General Ogilvie, Consultant Surgeon MEF, who kindly demonstrated it on two cases in the New Zealand base hospital in Helwan. Unfortunately, under the conditions sepsis was found to occur in a sufficient number of cases to make the employment of silk undesirable, and the operation was later prohibited in the British Army. When sepsis did arise the deeply embedded silk caused severe local disturbance and was very difficult to remove.

Fascial Repair: This was not often carried out except by the utilisation of viable fascia in the canal itself, such as a flap from the rectus sheath. Cases requiring this type of operation would generally be in the older age group. In this group, operation in the army overseas was deemed inadvisable for the more severe cases, who were graded or sent back to New Zealand.

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