US3266054A - Method for treatment of hernias - Google Patents
Method for treatment of hernias Download PDFInfo
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- US3266054A US3266054A US293070A US29307063A US3266054A US 3266054 A US3266054 A US 3266054A US 293070 A US293070 A US 293070A US 29307063 A US29307063 A US 29307063A US 3266054 A US3266054 A US 3266054A
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- Prior art keywords
- fragments
- treatment
- sclerosant
- gelatin
- tissue
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Links
- 238000000034 method Methods 0.000 title description 16
- 206010019909 Hernia Diseases 0.000 title description 8
- 239000012634 fragment Substances 0.000 description 25
- 239000003229 sclerosing agent Substances 0.000 description 16
- 108010010803 Gelatin Proteins 0.000 description 12
- 229920000159 gelatin Polymers 0.000 description 12
- 239000008273 gelatin Substances 0.000 description 12
- 235000019322 gelatine Nutrition 0.000 description 12
- 235000011852 gelatine desserts Nutrition 0.000 description 12
- WSFSSNUMVMOOMR-UHFFFAOYSA-N Formaldehyde Chemical compound O=C WSFSSNUMVMOOMR-UHFFFAOYSA-N 0.000 description 10
- 210000001519 tissue Anatomy 0.000 description 10
- 208000021970 Abdominal wall defect Diseases 0.000 description 8
- 210000002808 connective tissue Anatomy 0.000 description 8
- 238000001356 surgical procedure Methods 0.000 description 7
- 210000000494 inguinal canal Anatomy 0.000 description 6
- 206010016654 Fibrosis Diseases 0.000 description 5
- 230000004761 fibrosis Effects 0.000 description 5
- 230000035755 proliferation Effects 0.000 description 5
- PEDCQBHIVMGVHV-UHFFFAOYSA-N Glycerine Chemical compound OCC(O)CO PEDCQBHIVMGVHV-UHFFFAOYSA-N 0.000 description 4
- 239000008098 formaldehyde solution Substances 0.000 description 4
- 238000002347 injection Methods 0.000 description 4
- 239000007924 injection Substances 0.000 description 4
- 238000002690 local anesthesia Methods 0.000 description 4
- 239000000243 solution Substances 0.000 description 4
- 206010024769 Local reaction Diseases 0.000 description 3
- 230000003176 fibrotic effect Effects 0.000 description 3
- 239000002085 irritant Substances 0.000 description 3
- 231100000021 irritant Toxicity 0.000 description 3
- 238000004519 manufacturing process Methods 0.000 description 3
- 210000003205 muscle Anatomy 0.000 description 3
- XLYOFNOQVPJJNP-UHFFFAOYSA-N water Chemical compound O XLYOFNOQVPJJNP-UHFFFAOYSA-N 0.000 description 3
- 210000000683 abdominal cavity Anatomy 0.000 description 2
- 230000007547 defect Effects 0.000 description 2
- 239000011521 glass Substances 0.000 description 2
- 235000011187 glycerol Nutrition 0.000 description 2
- 210000000545 internal inguinal ring Anatomy 0.000 description 2
- 210000003041 ligament Anatomy 0.000 description 2
- 230000008961 swelling Effects 0.000 description 2
- 208000034657 Convalescence Diseases 0.000 description 1
- 241001269524 Dura Species 0.000 description 1
- LFQSCWFLJHTTHZ-UHFFFAOYSA-N Ethanol Chemical compound CCO LFQSCWFLJHTTHZ-UHFFFAOYSA-N 0.000 description 1
- 208000029836 Inguinal Hernia Diseases 0.000 description 1
- 125000003412 L-alanyl group Chemical group [H]N([H])[C@@](C([H])([H])[H])(C(=O)[*])[H] 0.000 description 1
- BQCADISMDOOEFD-UHFFFAOYSA-N Silver Chemical compound [Ag] BQCADISMDOOEFD-UHFFFAOYSA-N 0.000 description 1
- 230000003187 abdominal effect Effects 0.000 description 1
- 238000010521 absorption reaction Methods 0.000 description 1
- 238000006243 chemical reaction Methods 0.000 description 1
- 239000012153 distilled water Substances 0.000 description 1
- 230000000694 effects Effects 0.000 description 1
- 235000019441 ethanol Nutrition 0.000 description 1
- 229960004756 ethanol Drugs 0.000 description 1
- 239000000835 fiber Substances 0.000 description 1
- 239000012530 fluid Substances 0.000 description 1
- 230000035876 healing Effects 0.000 description 1
- 230000001939 inductive effect Effects 0.000 description 1
- 239000004615 ingredient Substances 0.000 description 1
- 210000000564 inguinal ring Anatomy 0.000 description 1
- 239000007788 liquid Substances 0.000 description 1
- 235000008409 marco Nutrition 0.000 description 1
- 244000078446 marco Species 0.000 description 1
- 239000000463 material Substances 0.000 description 1
- 238000002844 melting Methods 0.000 description 1
- 230000008018 melting Effects 0.000 description 1
- WSFSSNUMVMOOMR-NJFSPNSNSA-N methanone Chemical compound O=[14CH2] WSFSSNUMVMOOMR-NJFSPNSNSA-N 0.000 description 1
- 239000000203 mixture Substances 0.000 description 1
- 230000003014 reinforcing effect Effects 0.000 description 1
- 229920006395 saturated elastomer Polymers 0.000 description 1
- 238000012216 screening Methods 0.000 description 1
- 239000007787 solid Substances 0.000 description 1
- 230000004936 stimulating effect Effects 0.000 description 1
- 239000000126 substance Substances 0.000 description 1
- 210000000546 superficial inguinal ring Anatomy 0.000 description 1
- 210000002435 tendon Anatomy 0.000 description 1
Images
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/0063—Implantable repair or support meshes, e.g. hernia meshes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
Definitions
- Another object of the present invention is to provide a method and apparatus for treatment of the above type in which a sclerosant fragment is implanted in the human tissue in the vicinity of the abdominal wall defect, thus inducing the proliferation of connective tissue to form a large fibrosis which reinforces the tissue surrounding the defect.
- Still another object of the present invention is to provide a method for manufacturing sclerosant fragments for implanting in the tissue in the vicinity of the abdominal wall defect to stimulate the proliferation of hard connective tissue.
- a further object of the present invention is to provide a sclerosant fragment of the type described which will induce the proliferation of hard connective tissue, and which will be slowly absorbed by the host tissue over a period of two or three months, after which a hard connective tissue results for reinforcing the area surrounding the abdominal wall defect.
- FIGURE 1 is a perspective view of apparatus for manufacturing sclerosant fragments used in accordance with the present invention
- FIGURE 2 is a fragmentary perspective view of a gelatin sheet manufactured with the apparatus shown in FIGURE 1, and cut into long narrow slivers;
- FIGURE 3 is a perspective view of one of the slivers shown in FIGURE 2, after having been dried, hardened, and shrunk;
- FIGURE 4 is a side elevational view, with parts broken away, of a vial containing the fragment shown in FIG- URE 3 immersed in a formaldehyde solution to form a dissoluble sclerosant fragment for implanting in abdominal tissue;
- FIGURE 5 is a fragmentary top plan view of an incision, within which a group of sclerosant fragments have been implanted, and with sutures being applied to close the incision;
- FIGURE 6 is a transverse cross sectional view of the incision shown in FIGURE 5, with the sutures having been drawn taut and tied, completely implanting the sclerosant fragments within the incision.
- apparatus 10 in FIG- URE 1 is shown to include a shallow tray 18 for manufacturing sclerosant fragments for use in accordance with the present invention.
- This apparatus 10 includes a shallow tray 18, which forms a flat mold approximately two inches wide and six inches long, one-quarter of an inch deep, into which a liquid gelatin solution is poured.
- the gelatin solution preferably consists of three grams of powdered pure gelatin and twenty-five cc.s of distilled water. These ingredients are placed in a beaker and placed in a hot water bath until the gelatin has been com- 3,256,054 Patented August 9, 1966 pletely dissolved. To this mixture, one cc. of glycerin is added, and the solution then poured into the tray mold 18.
- the gelatin When the gelatin has set and solidified, it is removed in a sheet from the mold and cut transversely, by means of transverse cuts 20, into fragments two inches long, onequarter of an inch thick, and one-quarter of an inch wide. These fragments are then dried at eighty degrees Fahrenheit, following which the dried pieces are hardened, with some degree of elasticity, and shrunken in size to approximately One and three-quarters of an inch long by oneeighth of an inch thick, and one-eighth of an inch wide, thus producing individual fragments 24, as shown in FIG- URE 3.
- fragments 24 are then placed individually into glass vials 26 containing a formaldehyde solution 28 preferably consisting of one part of glycerin, two parts of grain alcohol, and two parts of formaldehyde, and the glass vials are flame sealed.
- a formaldehyde solution 28 preferably consisting of one part of glycerin, two parts of grain alcohol, and two parts of formaldehyde
- the gelatin fragments in this solution thus become saturated with the formaldehyde solution, causing a swelling of the fragments.
- the absorption of the formaldehyde makes the gelatin bland, brittle, non-melting, and sterile. After twenty-four hours, the fragments are ready to be used.
- the sclerosant fragments are implanted in the tissue as solids, to be slowly dissolved and absorbed by the host body tissue over a period of time ranging from eight to twelve weeks.
- the fragments constantly serve as a sclerosant for constantly stimulating a proliferation of hard connective tissue around the defect, without further treatment or hospitalization of the patient.
- This tissue forms a large fibrosis, the size of which depends upon the size of the hernial sac and the amount of the sclerosant fragments implanted.
- This fibrotic patch is eventually absorbed by the organism in two to three months, leaving only enough foundation of fibrosis to greatly reinforce the hernial region.
- the gelatin fragments may be provided in various sizes and the strength of the formaldehyde solution can be varied in strength. However, fragments produced in the manner hereinbefore described are versatile for the treatment of most abdominal wall defects.
- an indirect inguinal hernia may be treated in accordance with the present invention, as follows:
- a small skin incision is made about one and one-half inches long and parallel to Pouparts ligament and over the inguinal canal to expose the aponeurosis of the external oblique muscle, after which the external inguinal ring may be readily located.
- An incision of the aponeurosis of the external oblique muscle is then made, exposing the inguinal canal wherein is the spermatic c-ord, the hernial sac and the internal inguinal ring.
- the hernial sac is completely dissected out, then reduced or invaginated into the abdominal cavity through the internal inguinal ring.
- Two, three, or more sclerosant fragments, as described above, are then implanted on the top of the invaginated hernial sac.
- the inguinal canal is then closed, by means of well known techniques of surgery with silk, with the fibers of Pouparts ligament, Conjoin tendon and Rectus muscle.
- the fibers of Pouparts ligament, Conjoin tendon and Rectus muscle As a result, the invaginated hernial sac and the implanted gelatin fragments are buried under the sutures that closes the inguinal canal.
- This burying technique is of great importance in that it keeps the hernial sac and implanted gelatin pieces completely invaginated and reduced while the local reaction sets in.
- the reaction in turn, produces a fibrosis out of the hernial sac and surrounding host tissue, with the result that a fibrotic patch is formed firmly adhered posteriorly to the inguinal canal and internal ring, thus healing the hernia from Within.
- a method for the surgical treatment of hernia in a patient under local anesthesia comprising the steps of:
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Engineering & Computer Science (AREA)
- Surgery (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Veterinary Medicine (AREA)
- Public Health (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Cardiology (AREA)
- Vascular Medicine (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Pathology (AREA)
- Transplantation (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Prostheses (AREA)
Description
Aug. 9, 1966 M. JIMENEZ 3,256,054
METHOD FOR TREATMENT OF HERNIAS Filed July 5, 1963 Ala/r0: Jimene United States Patent "ice 3,266,054 METHOD FOR TREATMENT 9F HERNEIAS Marcos .iimenez, Apartado Postal No. 1784, Guadalajara, .ialisco, Mexico Filed July 5, 1963, Ser. No. 293,070 1 Claim. (Cl. 128-334) This invention relates to the treatment of abdominal wall defects and, more particularly, to a novel method and apparatus for providing a minor procedure for such treatment, thus avoiding drastic surgery.
It is an object of the present invention to provide an effective method for treating hernia and other abdominal wall defects which replaces drastic surgery and can be accomplished by means of local anesthesia.
Another object of the present invention is to provide a method and apparatus for treatment of the above type in which a sclerosant fragment is implanted in the human tissue in the vicinity of the abdominal wall defect, thus inducing the proliferation of connective tissue to form a large fibrosis which reinforces the tissue surrounding the defect.
Still another object of the present invention is to provide a method for manufacturing sclerosant fragments for implanting in the tissue in the vicinity of the abdominal wall defect to stimulate the proliferation of hard connective tissue.
A further object of the present invention is to provide a sclerosant fragment of the type described which will induce the proliferation of hard connective tissue, and which will be slowly absorbed by the host tissue over a period of two or three months, after which a hard connective tissue results for reinforcing the area surrounding the abdominal wall defect.
All of the foregoing and still further objects and advantages of this invention will become apparent from a study of the following specification, taken in connection with the accompanying drawing, wherein:
FIGURE 1 is a perspective view of apparatus for manufacturing sclerosant fragments used in accordance with the present invention;
FIGURE 2. is a fragmentary perspective view of a gelatin sheet manufactured with the apparatus shown in FIGURE 1, and cut into long narrow slivers;
FIGURE 3 is a perspective view of one of the slivers shown in FIGURE 2, after having been dried, hardened, and shrunk;
FIGURE 4 is a side elevational view, with parts broken away, of a vial containing the fragment shown in FIG- URE 3 immersed in a formaldehyde solution to form a dissoluble sclerosant fragment for implanting in abdominal tissue;
FIGURE 5 is a fragmentary top plan view of an incision, within which a group of sclerosant fragments have been implanted, and with sutures being applied to close the incision; and
FIGURE 6 is a transverse cross sectional view of the incision shown in FIGURE 5, with the sutures having been drawn taut and tied, completely implanting the sclerosant fragments within the incision.
Referring now to the drawing, apparatus 10 in FIG- URE 1, is shown to include a shallow tray 18 for manufacturing sclerosant fragments for use in accordance with the present invention. This apparatus 10 includes a shallow tray 18, which forms a flat mold approximately two inches wide and six inches long, one-quarter of an inch deep, into which a liquid gelatin solution is poured. The gelatin solution preferably consists of three grams of powdered pure gelatin and twenty-five cc.s of distilled water. These ingredients are placed in a beaker and placed in a hot water bath until the gelatin has been com- 3,256,054 Patented August 9, 1966 pletely dissolved. To this mixture, one cc. of glycerin is added, and the solution then poured into the tray mold 18.
When the gelatin has set and solidified, it is removed in a sheet from the mold and cut transversely, by means of transverse cuts 20, into fragments two inches long, onequarter of an inch thick, and one-quarter of an inch wide. These fragments are then dried at eighty degrees Fahrenheit, following which the dried pieces are hardened, with some degree of elasticity, and shrunken in size to approximately One and three-quarters of an inch long by oneeighth of an inch thick, and one-eighth of an inch wide, thus producing individual fragments 24, as shown in FIG- URE 3. These fragments 24 are then placed individually into glass vials 26 containing a formaldehyde solution 28 preferably consisting of one part of glycerin, two parts of grain alcohol, and two parts of formaldehyde, and the glass vials are flame sealed. The gelatin fragments in this solution thus become saturated with the formaldehyde solution, causing a swelling of the fragments. The absorption of the formaldehyde makes the gelatin bland, brittle, non-melting, and sterile. After twenty-four hours, the fragments are ready to be used.
In the past, surgeons have sought to improve their techniques in the treatment of abdominal wall defects by using various foreign materials, such as silver wire filagree or screening to strengthen the hernial area. In addition, injections of irritant substances, with sclerosant properties, have been used to stimulate a certain degree of proliferation of connective tissue. However, the fact that such injectionable irritants are fluids and are absorbed rapidly by the tissue, has minimized the useful effect of such sclerosants, such that a very high number of such injections are required to produce even a slight amount of connective tissue. In accordance with the present invention, however, painful injection of such irritants in the patient are avoided, and the sclerosant fragments are implanted in the tissue as solids, to be slowly dissolved and absorbed by the host body tissue over a period of time ranging from eight to twelve weeks. During this extended period of time, the fragments constantly serve as a sclerosant for constantly stimulating a proliferation of hard connective tissue around the defect, without further treatment or hospitalization of the patient. This tissue forms a large fibrosis, the size of which depends upon the size of the hernial sac and the amount of the sclerosant fragments implanted. This fibrotic patch is eventually absorbed by the organism in two to three months, leaving only enough foundation of fibrosis to greatly reinforce the hernial region.
The gelatin fragments may be provided in various sizes and the strength of the formaldehyde solution can be varied in strength. However, fragments produced in the manner hereinbefore described are versatile for the treatment of most abdominal wall defects.
By way of example, an indirect inguinal hernia may be treated in accordance with the present invention, as follows:
Employing local anesthesia, a small skin incision is made about one and one-half inches long and parallel to Pouparts ligament and over the inguinal canal to expose the aponeurosis of the external oblique muscle, after which the external inguinal ring may be readily located. An incision of the aponeurosis of the external oblique muscle is then made, exposing the inguinal canal wherein is the spermatic c-ord, the hernial sac and the internal inguinal ring. The hernial sac is completely dissected out, then reduced or invaginated into the abdominal cavity through the internal inguinal ring. Two, three, or more sclerosant fragments, as described above, are then implanted on the top of the invaginated hernial sac. The inguinal canal is then closed, by means of well known techniques of surgery with silk, with the fibers of Pouparts ligament, Conjoin tendon and Rectus muscle. As a result, the invaginated hernial sac and the implanted gelatin fragments are buried under the sutures that closes the inguinal canal.
This burying technique is of great importance in that it keeps the hernial sac and implanted gelatin pieces completely invaginated and reduced while the local reaction sets in. The reaction, in turn, produces a fibrosis out of the hernial sac and surrounding host tissue, with the result that a fibrotic patch is formed firmly adhered posteriorly to the inguinal canal and internal ring, thus healing the hernia from Within.
The local reaction of swelling and soreness will reach its peak in approximately three days after the sclerosant fragments have been implanted. Within a Week, most of the soreness is gone and the hard mass of connective tissue surrounding the entire treated area may be palpated by the examining fingers. This mass will be slowly absorbed, being reduced substantially in size in approximately one month, and in approximately three months will have become a firm and strong region.
It will thus be recognized that a method for treating abdominal wall defects has been provided which avoids drastic surgery which is ordinarily required for such treatment. This procedure is accomplished by means of local anesthesia, allowing the patient to walk from the operating room to carry on normal functions immediately after treatment. This reduces the period of convalescence of the patient, reducing cost and expense and time of incapacity.
While this invention has been described with particular reference to the method, technique and sclerosant fragment illustrated, it is to be understood that such is not to be construed as imparting limitations upon the invention, which is best defined by the claim appended hereto.
Having thus described my invention, I claim as new and desire to secure by Letters Patent:
A method for the surgical treatment of hernia in a patient under local anesthesia comprising the steps of:
(a) making an incision to expose the inguinal canal which contain the hernial sac and the inguinal ring;
(b) dissecting out said sac;
(c) invaginating said sac through said ring into the abdominal cavity;
(d) implanting a plurality of strips of formaldehyde treated gelatin inside of the invaginated sac; and
(e) closing a suture at the base and around the sac thus burying said strips in the sac and the sac in said cavity to produce by local reaction a fibrosis in the form of a. fibrotic patch firmly adhered posteriorly to the canal and ring whereby the hernia is healed from within.
References Qited by the Examiner UNITED STATES PATENTS 611,814 10/1898 Millar 260117 2,039,262 4/1936 Schulte 128335.5 2,236,542 4/1941 Lukens 128--335.5 2,465,357 3/1949 Correll 167-84 OTHER REFERENCES Kretzschman: The Injection Treatment of Hernia, from Clinical Med. & Surgery, vol. 42, No. 8, August, 1935, pp. 371-75.
Mason et al.: Use of Homologous Dura Matter in the Repair of Hernias, from Archives of Surgery, vol. 82,
RICHARD A. GAUDET, Primary Examiner.
DALTON L. TRULUCK, Examiner.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
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US293070A US3266054A (en) | 1963-07-05 | 1963-07-05 | Method for treatment of hernias |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
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US293070A US3266054A (en) | 1963-07-05 | 1963-07-05 | Method for treatment of hernias |
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US3266054A true US3266054A (en) | 1966-08-09 |
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US293070A Expired - Lifetime US3266054A (en) | 1963-07-05 | 1963-07-05 | Method for treatment of hernias |
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Cited By (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3454011A (en) * | 1966-12-28 | 1969-07-08 | Marvin Wagner | Sutures and prosthetic patches |
US5383477A (en) * | 1991-08-02 | 1995-01-24 | Dematteis; Ralph A. | Method and apparatus for laparoscopic repair of hernias |
US20110082479A1 (en) * | 2009-10-07 | 2011-04-07 | Jack Friedlander | Apparatus, method and system for the deployment of surgical mesh |
Citations (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US611814A (en) * | 1898-10-04 | Adam millar | ||
US2039262A (en) * | 1933-02-11 | 1936-04-28 | Koninklijke Pharma Fab Nv | Process for the manufacture of threads, strings, bands, films, and the like |
US2236542A (en) * | 1938-03-02 | 1941-04-01 | Clarence D Lukens | Surgical suture |
US2465357A (en) * | 1944-08-14 | 1949-03-29 | Upjohn Co | Therapeutic sponge and method of making |
-
1963
- 1963-07-05 US US293070A patent/US3266054A/en not_active Expired - Lifetime
Patent Citations (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US611814A (en) * | 1898-10-04 | Adam millar | ||
US2039262A (en) * | 1933-02-11 | 1936-04-28 | Koninklijke Pharma Fab Nv | Process for the manufacture of threads, strings, bands, films, and the like |
US2236542A (en) * | 1938-03-02 | 1941-04-01 | Clarence D Lukens | Surgical suture |
US2465357A (en) * | 1944-08-14 | 1949-03-29 | Upjohn Co | Therapeutic sponge and method of making |
Cited By (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3454011A (en) * | 1966-12-28 | 1969-07-08 | Marvin Wagner | Sutures and prosthetic patches |
US5383477A (en) * | 1991-08-02 | 1995-01-24 | Dematteis; Ralph A. | Method and apparatus for laparoscopic repair of hernias |
US20110082479A1 (en) * | 2009-10-07 | 2011-04-07 | Jack Friedlander | Apparatus, method and system for the deployment of surgical mesh |
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