Lloyd M. Nyhus

Clinical experiences with preperitoneal hernial repair for all types of hernia of the groin, with particular reference to the importance of transversalis fascia analogues.

Abstract 1. 1. The principle of preperitoneal laminar restoration of the anatomy and the importance of the transversalis fascia lamina in hernial repair of the groin are emphasized. 2. 2. The structures which are actually used for repair are a group of local ligaments within the transversalis fascia. We have designated these structures as transversalis fascia analogues. In direct hernial repair, for example, superomedial transversalis fascia is joined to inferolateral transversalis fascia analogues (Coopers ligament and iliopubic tract). 3. 3. The surgical anatomy of the transversalis fascia and the transversalis fascia analogues is described. 4. 4. One hundred fifty patients with hernias of the groin have been operated upon by the preperitoneal approach; this represents an experience of 213 separate hernial repairs (forty-eight femoral, sixty direct, and 105 indirect inguinal hernias). 5. 5. A recurrent hernia rate of approximately 2 per cent was found. All but one recurrence followed repair of indirect inguinal hernias by a technic discarded by us over two years ago. There have been no recurrences following indirect hernial repair by the technic herein described.

A physiologic study of motility changes following selective gastric vagotomy

Summary Physiologic studies were done in dogs with stimulation of the thoracic vagus and recording of motility changes in the abdominal viscera, namely the stomach, first part of the duodenum, third part of the duodenum, jejunum, ileum, colon and gallbladder. We have shown by this technique that: o 1. Following selective gastric vagotomy, the motility response in the stomach is totally absent while the remaining viscera are reactive. 2. The influence of the gastric branches from either right or left trunk extends through the second part of the duodenum. 3. The hepatic branch of the left vagus innervates the gallbladder and proximal duodenum but has no influence on the stomach. 4. The celiac branch influences the entire gastrointestinal tract from the proximal duodenum through the ascending colon. 5. Selective gastric vagotomy may prove to be a logical refinement of total abdominal vagotomy.

The Vagal Nerve and the Intestinal Phase of Gastric Secretion

Summary In Heidenhain pouch dogs with selective vagotomy, total gastrectomy (aside from the pouch), and esophagoduodenostomy, the output of acid from the pouch was increased after total abdominal vagal denervation as compared to when abdominal vagal innervation was intact.

Demonstration of the functional anatomy of the canine gastric antrum

Abstract Technics are described for visual delineation of the corpus-antrum boundary in canine stomachs. These technics involve various dye-stuffs, neutral red, toluidine blue, Congo red, and fluorescein. This study shows that differences in intravenous dye excretion in the gastric corpus as compared with the gastric antrum can be exploited to reveal anatomic limits of the antrum, Color differences obtained in this way were observed to correspond to areas of different pH values, but the color differences result basically from the presence or absence of dye excretion which is a major feature of this study. Gastric color boundaries from dyestuffs were marked and compared with histologic corpusantrum boundaries. Color boundaries obtained are accurate and reproducible. Furthermore, color boundaries are easily seen; use of a layer of gauze upon gastric mucosa provides a white background against which dyestuffs are vivid. Some comparative features of these dyestuffs are discussed. Possible applicability of these technics includes operations in which the gastric corpus and antrum are to be separated or in which the corpus-antrum boundary is to be marked for future reference in experiments.

Influence of the vagus nerve on the inhibitory effect of fat in the duodenum

SummaryIn 4 mongrel dogs with a Heidenhain pouch, selective gastric vagotomy, total gastrectomy, and an esophagoduodenostomy, the influence of vagotomy on inhibition of gastric secretion by fat in the duodenum was assessed. The amount of inhibition with the duodenum vagally innervated was not significantly different from the amount of inhibition when the duodenum was vagally denervated by truncal vagotomy. It is concluded that complete vagotomy does not interfere with the release of the inhibiting humoral substance released by fat in the duodenum.

The Effect of Vagal Block or Hexamethonium on Gastric Secretion in the Dog

Because of relevance to the operation of vagotomy in man, and to ‘medical vagotomy’ tests attempting to forecast the results of surgery, we have made a study in the dog of the effects of (1) blocking the vagus nerves with local anaesthetic and (2) injecting intravenously a ganglion-blocking drug. Gastric secretion was stimulated with both high and low doses of histamine and gastrin in dogs equipped with either a Heidenhain or a Pavlov pouch. Although the blocking procedures abolished acid and pepsin secretion caused by a pure vagal stimulant (2-deoxy-D-glucose) they had less effect against gastrin, and still less against histamine. The implications of these results are discussed.

Selective vagal effects on the intestinal phase of gastric secretion.

EDITORIAL SYNOPSIS Evidence is presented from studies in dogs with Heidenhain pouches and with the remainder of the stomach removed that total vagotomy increases the response of the pouch to the intestinal phase of acid secretion. The relative importance of the anterior and posterior vagal trunks has been studied by dividing these separately. Of the various theoretical explanations for this finding, the authors favour a prolongation of the release of the intestinal humoral-stimulating agent in the vagotomized intestine as a major factor.

The role of the antrum in the surgical treatment of peptic ulcer.

Summary The antrum has gained much lost ground in the past few years. From a point low in the estimation of surgeons, the antrum has become recognized as a friend, if certain controls are placed on its activity. The sine qua non of antral retention would seem to be twofold: (1) a position in continuity with acid-secreting cells; and (2) vagotomy of the antrum itself The history of the antrum in the operative approach to peptic ulcer disease has been long and varied. Utilizing these clinical experiences and profiting from the data of experimental laboratories, surgeons have progressed far in solving the enigma of the gastric antrum.

The Effect of Atropine on Gastric Secretion in the Dog

Experiments were performed on dogs with a Pavlov or a Heidenhain pouch. The action of atropine in inhibiting the secretion of acid and pepsin was studied when secretion was stimulated with high and low doses of either histamine or gastrin given by steady intravenous infusion. It is shown that the effects on responses to gastrin are much greater than those on responses to histamine; that this is not a phenomenon peculiar to pouches of the stomach; and that the synthetic pentapeptide I.C.I. 50, 123 is affected similarly to porcine gastrin. It is suggested that these results should be interpreted as showing that gastrin stimulates gastric secretion indirectly by exciting neurones in the intramural plexus.

Effects of calcium infusion on gastric secretion in Heidenhain pouch dogs.

Calcium salts were infused against a background of stimulation by histamine or porcine gastrin or against the release of endogenous gastrin (feeding test). Raising the plasma calcium to values note...