An Address ON METHODS OF INCISING, SEARCHING, AND SUTURING THE KIDNEY: Delivered before the New York State Medical Society
Authors: H. A. Kelly
Journal: BMJ (1902)

OF KIDNEY. [FIB. 1, I902.This was not always secured by the early plans of suturing the adipose tissue, the fibrous capsule, or. the kidney paren chyma to the lumbar muscle or aponeurosis.Many needlessly complicated plans have been advised.Tuffier's, Lane's, and others seem to me to come under this category.A simple and satisfactory plan is to separate the kidney from its fatty capsule by free dissection with the finger, to irritate the fibrous capsule by scratching with a scalpel, to fix the lower part of the kidney by two sutures of catgut, silk, kangaroo tendon, or silkworm gut to the lumbar muscles and aponeurosis, and, most important of all, to insert alongside the kidney large drainage tubes orpacks of gauze, which are left in for a week to produce aseptic inflammation and granulation.Alternatively, instead of sutures, bridles of gauze maybe passed over the upper and lower poles of the kidney, and tied over gauze packing running alongside the kidney, the wound healing up by granulation.Excellent results have followed the first method in my hands, but I prefer the second, which I believe was first suggested by Senn.It certainly obviates the alleged risks of suture-namely, urinary 'infiltration, abseess of the kidney, and cirrhosis of the kidney.The following ten cases of movable kidney have come under my care during the last three years:CASe I.-Right Movable Kidney: Marked Gastric Symptoms: Nephropezy: Cure.Mrs. C. aged 50, multipara, was seen some two years ago.Her history was that kor four yearsshe had suffered from dragging pain in the side, and that recently she had been much troubled with vomitin She was wasting rapidly, and had most of the symptoms of pyloric obstruction.She looked cachectic, and I at first suspected malignant disease Examination showed a very movable kidney, which could be pushed down to the brim of the pelvis, had the characteristic tenderness of the kidney and on reposition could be palpated bimanually.Operation was advised, and she came into the Northern Nursing Home for that purpose.The day's rest there improved her so much that she asked for a respite from operation.The symptoms returned immediately she began to get about, and she came back for nephropexy, which was absolutely success- ful in removing all the symptoms.I saw her recently, when she stated that she had been in perfect health ever since operation.CASE II.-Right Movable Kidney: Marked Gastric Symptoms: Nephropexy: Cure.Mrs. C., aged about 6o, was transferred to my ward in the infirmary by Dr. Lister.She had been sent to the infirmary for symptoms which pointed to malignant disease of the stomaeh.Dr. Lister discovered a movable kidney, and rest in bed removed the more troublesome symptoms, and prepared her for operation, which was done about eight months ago.The kidney, as in the first case, was found to be movable as far as the brim of the pelvis.When the patient left hospital all her symptoms had disappeared.I examined her the other day, and found the kidney immovable.She is still neurasthenic.CASE III.