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  • Pope Pius XI Hernia Repair

    Posted by kaspa on August 25, 2019 at 9:23 pm

    Some famous people have had hernia repairs. I found this one, which seems quite remarkable.

    Before being Pope Pius XI, Achille Ratti lived in Poland from 1918 to 1921 after appointment by Pope Benedict XV (first as Apostolic Visitador and later as Apostolic Nuncio).

    He had his hernia repaired by a Polish surgeon who developed a modified Bassini repair in which all he did was dissecting the neck of the hernia sac, ligating and cutting it and leaving the cut sac „in
    situ”.

    Surgery was done by Dr. Zdzisław Sławiński, from Warsaw. It’s hard to find any literature about his technique as it is described in a 1916 Polish paper (see below). That made his hernia repair famous, known as “Polish Repair”. This was the commonest repair done in Poland until the 1950’s with good results (Then came the mesh…).

    Anyway, Dr. Zdzisław Sławiński is best known from his developments in Vascular Surgery.

    I’m not sure when Pope Pius XI did surgery, as he lived in Poland from 1918-1921 and some sources claim he had his hernia repaired in 1925 (when he was Pope). If it was in 1925, then it’s possible he knew the Polish surgeon and asked him to go to Rome. When I can, I’ll do a newspaper research to make that clear.

    Pope Pius XI had poor health, but he lived until 1939 (82 years-old) and nowhere is stated that his hernia had a recurrence or complication.

    This is quite interesting in that simply repairing hernia sac had hernia cured. I think having a wall defect isn’t enough to have an inguinal hernia. You’ll need an hernia sac to form so that contents are guided though the defect. Hernia sac formation is likely a random event, so hernia can recur if another sac forms, but that can years or even never happen again.

    Original references I could find:

    Sławiński Z. Uproszczony sposb operowania przepukliny pachwinowej. Pamiętniki Towarzystwa Lekarskiego Warszawskiego 112:206-208(1916)
    Dryjski J. Spostrzeżenia nad wartością “polskiej metody” operacji przepuklin pachwinowych. Polski Przegląd Chirurgiczny 22: 674–679(1950)

    Google translation:

    Sławiński Z. A simplified method of inguinal hernia surgery. Memoirs of the Warsaw Medical Society 112:206-208(1916)
    Dryjski J. Observations on the value of the “Polish method” of inguinal hernia surgery. Polish Surgical Review 22: 674–679(1950)

    Maybe some member can get these articles in Poland.

    UhOh! replied 4 years, 7 months ago 3 Members · 5 Replies
  • 5 Replies
  • UhOh!

    Member
    August 27, 2019 at 10:28 pm
    quote kaspa:

    That’s it, but how can one explain that simple ligation in adults was that successful in Poland until the 1950’s, including Pope Pius XI in his sixties?

    I can think of several potential explanations of such phenomenon, NONE of which I have any actual evidence to support (they are just general ways to explain this type of discrepancy):

    1. Population homogeneity. I doubt anyone has ever done a study on different hernia characteristics across demographics (other than, perhaps, sex and age) and perhaps there was something inherent in ethnic Poles making them less susceptible to the dilation Dr. Brown references above. You wouldn’t see that in the U.S. today, given the heterogeneity of the population.

    2. General health/nutrition. Not sure how, but they’ve linked dietary changes over the years to all kinds of other health changes, so perhaps it had an impact on muscle elasticity/tissue quality?

    3. Recording of statistics. Perhaps there was a 35% recurrence rate, but if there weren’t good records kept, then we wouldn’t know that today.

    4. Life expectancy. If it was shorter (and I’m sure it was) people probably retired, and reduced physical activity, earlier, meaning the repair didn’t have to last as long.

  • kaspa

    Member
    August 27, 2019 at 9:33 pm

    That’s it, but how can one explain that simple ligation in adults was that successful in Poland until the 1950’s, including Pope Pius XI in his sixties?

  • DrBrown

    Member
    August 27, 2019 at 7:59 pm

    [USER=”1391″]UhOh![/USER]
    In infants, simple ligation of the sac is all that is required.
    In adults, the sac has usually dilated in the internal ring and the ring needs to be tightened (sometimes called a ringplasty).
    Regards
    Bill Brown MD

  • UhOh!

    Member
    August 27, 2019 at 2:27 am
    quote DrBrown:

    [USER=”2862″]kaspa[/USER]
    Thank you for the history lesson.
    For infants, simple ligation of the hernia sac is all that is required.
    This would be similar to the operation the Pope had.
    Regards.
    Bill Brown MD

    How does this compare to the Marcy repair, as you describe it on your website? Just the fact that the Marcey involves using sutures to narrow the internal ring (instead of leaving it be to develop properly, as in a child)?

  • DrBrown

    Member
    August 26, 2019 at 4:16 am

    [USER=”2862″]kaspa[/USER]
    Thank you for the history lesson.
    For infants, simple ligation of the hernia sac is all that is required.
    This would be similar to the operation the Pope had.
    Regards.
    Bill Brown MD

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