J.Jpn. Surg. Soc.. 81(9): 1217-1220, 1980
Report on the annual meeting
WATANABE'S HERNIOTOMY (ORIGINATED IN 1961)
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Mito National Hospital Surgical Department Akira Watanabe, Akushi Murakami, Michitaka Okamoto |
As he had a strong conviction that his method was recommendablef or any surgeon, he introduced it at the Cine-Symposium of the 80 th Japanese Society of Surgery. The detail is as follows. Under anesthesia, skin incision is made over the inguinal area, horizontaly or obliquely. The superficial layers is separated bluntly or sharply. A field of vision was widened with retractors and the aponeurosis of the external oblique is brought into view. Superficial inguinal ring is grasped with two straight Pean's forceps, and the aponeurosis of the external oblique and its superficial inguinal ring are opened with a operative knife in the direction of its fibres. Next the hernia content is put back to the peritoneal cavity, the deep; inguinal ring can be seen.
After the hernial sac is opened near the deep inguinal ring, the portal area of the hernia is grasped with four Pean's forceps and the spermatic cord is seen through under the posterior wall of the hernial sac. A purse string suture with 3-0 or 4-0 silk is perrfomed around the portal area without traumatizing the spermatic cord. At this time, it is very important that the suturing thread is pull through not only the peritoneum but also the internal spermatic fascia. This procedure is killing two birds with one stone because the high ligation of the hernial sac and the protection of the spermatic cord is possible. Moreover this procedure is very easy one because using only one purse string suture. Repair of the inguinal canal is performed by a method much the same as Ferguson-Bassini's.
After all the internal oblique muscle is fastened to Poupart's ligament with three interrupted stitches, the aponeurosis of the external oblique muscle is closed with three or four interrupted stitches and closure of the skin wound is made, and operation is over.
The time required for this maneuver is five to ten minutes for a proficient surgeon and twenty to thirty minutes for a beginner. Bleeding in this operation doesn't be occured at all because this method contains neither the peeling of the hernial sac nor the incision of the cremaster muscle. So the compression dressing is no need and this operating method becomes very simplifing. Owing to this new operating method, the radical operation for infant's indirect inguinal hernia doesn't have to admit and 527 cases as of December in 1979 were carried out with this procedure. It is a very pleasure to be given a trial for this procedure by many surgeons.
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