Have a syringe loaded with paraffin mixture number one and another
loaded with sterile vaseline. See that the paraffin flows smoothly
from the syringe without leaks. See also that the vaseline syringe is
working smoothly.
Have needles intended for injection of paraffin free from this agent.
Place patient on back, thighs flexed slightly or straight if the
external ring is easily accessible. Follow the spermatic cord and
locate definitely the external ring.
Attach empty syringe to needle. Pass needle point through skin. As
soon as needle point is through skin exhaust syringe. That is draw
piston out to form vacuum in syringe and obtain suction. Pass the
needle slowly through external ring and along close to the roof of
inguinal canal.
When needle is in full length, if no vein has been struck and blood
aspirated into the syringe, detach syringe and screw the paraffin
syringe tightly to needle.
Inject a few drops of paraffin by screwing down syringe. As paraffin
is flowing move the point of the needle about in the loose cellular
tissue and continuing the injection slowly withdraw the needle.
Continue moving the point of the needle in all directions as the
needle is withdrawn so that the paraffin will be diffused as much as
possible. As the point of the needle emerges between the pillars of
the external ring discontinue the injection.
Test the effectiveness of the injection.
Allow patient to stand on feet. If the hernia reappears have the
patient lie down again and reinsert the needle as before described and
inject sterile vaseline rather than the paraffin mixture.
Not more than enough paraffin to half fill the canal should be
injected. If such quantity does not hold hernia sterile vaseline
should be used discreetly until hernia is held.
The surgeon must estimate the approximate size of the inguinal canal
by the size of the external ring.
If a vein is struck the needle should be withdrawn and the syringe
emptied of blood; then the needle should be reinserted, using the
syringe for suction. If a vein is struck a second time it will be well
to insert the needle through the abdominal wall at the site of the
internal ring and if no vein is struck at this point an injection may
be made. If this holds the hernia it may be well to make no injection
of canal for two weeks. During the interval even if the hernia does
not recur it will be well for patient to wear web bandage truss or a
spica bandage with a pad pressure over the inguinal canal. At the end
of two weeks inject canal moderately with paraffin or vaseline to
promote formation of connective tissue.
If the injection of the canal at the site of the internal ring does
not hold the hernia, reduce the same and make a puncture with a small
needle through the external wall of the canal just above the external
ring. If no vein is struck inject moderately and see if such injection
holds hernia. In such a case place pad of moderate size over the canal
and put on firm spica and have the patient stay off of feet as much as
possible for ten days or two weeks. In this case the permanence of the
cure will depend upon the amount of connective tissue formed.
Injection at Internal ring.
To inject through the abdominal wall at the internal ring select a
point midway between the anterior superior spine of the ilium and the
pubes and one-half an inch above the line of Poupart's ligament. This
represents the site of the internal ring. The needle should be pressed
through the fibrinous wall of the canal at this point and should be
directed towards the pubes. If the hernia is at all large remember
that the canal is shortened and select a point one-half or
three-quarters of an inch nearer the pubes as the site of the ring.
When through the outer wall of the inguinal canal the needle point
will have a considerable freedom in the loose cellular tissue and the
injection should be diffused in a circle of an inch or an inch and a
half in diameter. Before taking off the suction syringe after the
passage of the needle sweep the point slowly in a circle to make sure
that no vein has been opened or is likely to be opened as the needle
is swept about.
The hypodermic needle for injection.
A hypodermic needle may be used for an internal ring injection or an
injection through the anterior wall of the canal, but in moving it
about the operator should watch carefully and not break such needle.
If a needle breaks it will be at the shoulder formed by the point of
attachment of the shaft of the needle with the butt.
The advantage of the small hypodermic needle is that it may be passed
with very little discomfort to the patient and it throws a finer
string of paraffin and favors diffusion of the agent.
A hypodermic needle is lacking in length to inject the canal when
passed through the external ring along the canal.
Should the surgeon attempt injection along the canal and find the
patient too nervous or the technic too difficult the hypodermic may be
used and an injection made through the anterior wall of the canal at
the internal ring, at about the center of the canal and about one-half
an inch from the external ring.
The hypodermic needle injections are simple and should be accomplished
even on a very nervous patient without troubling to infiltrate with
cocain or alypin.