Surgery: A Rupture & a Polyp

An incisional hernia such as the one from which President Johnson is now suffering is a rupture (Latin: hernia) or break in the muscular abdominal wallIn the President’s case, the break came about an inch to the right of the scar where the surgeons cut last year to remove his gall bladder. It is at the point where plastic drain tubes were left in place for four days after that operation. Such hernias are by no means rare but no one knows exactly how common they are.

Delicate Dissection. One surgery textbook argues that “the pathologic anatomy of incisional hernia is a story of surgical failure.” But that is not a reflection on the surgeon, rather it is a reflection on the patient’s anatomy. An unathletic man like the President is likely to have relatively weak belly muscles, and L.B.J.’s have been further weakened by his weight gain of almost 20 Ibs. in the past year. The intestines and other internal organs, exerting pressure against the muscle wall, found a weak spot at the drain site and forced an opening. A piece of intestine (it may be either the large or small bow el) has pushed through. Finger-tip size in April, it is now as big as a golf ball.

There is little risk that a hernia at this site will become strangulated, but the President did suffer discomfort from clothing rubbing against the tender, stretched skin that might have become ulcerated. Though the operation to push the protruding gut back and close the rupture securely is not dangerous, it demands exquisitely delicate dissection and needlework because the muscle fibers are layered and crisscrossed like the Warp and woof of a carpet.

Light & Knife. The polyp (from the Greek polypodos, many-footed) near the President’s vocal cord is a soft growth that looks something like a miniature octopus. Polyps are common in many parts of the body; misuse of the vocal cords seems to encourage their development in the larynx. The great majority are benign tumors, but while the President is still under the anesthetic, his polyp will be cut up and examined under the microscope to make sure there is no malignancy. Removal is a simple matter of inserting a tube with a light at the end down the throat and slipping a basket-shaped forceps down the tube to snip off the polyp.

Though the hernia repair (herniorrhaphy) requires general anesthesia and is not “minor surgery,” both the operations that Johnson needs are low-risk procedures. Because the patient is the President, however, his operating room will be filled with a reinforced brigade of topnotch physicians and surgeons. > Vice Admiral George G. Burkley, 64, a specialist in administration and in internal medicine, is the President’s resident physician in the White House. > James C. Cain, 53, a Mayo Clinic internist, is a Texas-born buddy of thePresident and his longtime but long-range personal physician. >Kenneth D. Devine, 49, is a Mayo Clinic plastic surgeon and otolaryngologist (meaning ear-and-throat specialist). > Wilbur J. Gould, 47, from Manhattan’s Lenox Hill Hospital, is the otolaryngologist who has been looking down the President’s throat since August. >George A. Hallenbeck, 51, is the Mayo Clinic general surgeon specializing in gastroenterology who took out the President’s gall bladder. > J. Willis Hurst, 46, now of Atlanta, is the ex-Navy cardiologist who cared for the President during and after his 1955 heart attack. > Edward Paul Didier, 41, from the Mayo Clinic, is the anesthesiologist who directed the anesthesia during the gallbladder operation.