. A new manual of surgery, civil and military. operationsome twelve years ago, which has made the results in this form of herniotomyquite as satisfactory as in the inguinal variety. The operation comprises the following steps: (1) Transverse elliptical incisions are surrounding the umbilicusand hernia; deepened to the base of the hernial protrusion. (2) The surfaces of the aponeurotic structures are carefully cleared aninch and a half in all directions from the neck of the sac. (3) The fibrous and peritoneal coverings of the hernia are divided in acircular manner at the neck, exposing it
. A new manual of surgery, civil and military. operationsome twelve years ago, which has made the results in this form of herniotomyquite as satisfactory as in the inguinal variety. The operation comprises the following steps: (1) Transverse elliptical incisions are surrounding the umbilicusand hernia; deepened to the base of the hernial protrusion. (2) The surfaces of the aponeurotic structures are carefully cleared aninch and a half in all directions from the neck of the sac. (3) The fibrous and peritoneal coverings of the hernia are divided in acircular manner at the neck, exposing its contents. If intestinal viscera arepresent the adhesions are separated and restitution made. The containedomentum is ligated and removed with the entire sac of the hernia. (4) With forceps the margins of the ring are grasped and approximated GENERAL SURGEEY OF THE ABDOMEN 349 Whichever way the overlapping is more easy of accomplishment, suggests thedirection of the closure. The illustrations show the overlapping as done fromabove u. Hernia. Eepresents the hernial ring in an umbilical hernia laid bare, -with the tissues dissected backdown to the aponeurosis. Two fingers of one hand are inserted into the abdominal cavityin order to protect the intra-abdominal organs against injury from the needle, which is insertedone and one-half to two inches from the edge of the ring. A blunt hook is inserted on eitherside to stretch the ring transversely. (5) For this approximation an incision is made through the aponeuroticand peritoneal structures of the ring extending one inch or more transverselyto each side, and the peritoneum is separated from the under surface of theupper of the two flaps thus formed. 350 GENERAL SURGERY OF THE ABDOMEN (6) Beginning from one to one and one-half inches above the marginof the upper flap, three to four chromicized catgut mattress sutures are intro-duced, the loop firmly grasping the upper margin of the lower flap; sufficienttraction is made o
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Keywords: ., bookcentury1900, bookdecade1910, bookpublishe, booksubjectsurgery
