Annals of surgery . is the least mischievous of the three directions whichthe infundibulum may assume in this method of dealing withthe neck of the sac, and the last named (forward, downward,and medianward) is the most harmful,—yet all of them di-rectly and absolutely invite a recurrence of the hernia, as doesits analogue, the depression which occurs at the site of the 6o6 GEORGE RYERSON FOWLER. internal ring following the completion of the descent of thetesticle. (Diagram B.) The length of time which this takeswill depend upon the support which the external structuresgive to the infundibulum
Annals of surgery . is the least mischievous of the three directions whichthe infundibulum may assume in this method of dealing withthe neck of the sac, and the last named (forward, downward,and medianward) is the most harmful,—yet all of them di-rectly and absolutely invite a recurrence of the hernia, as doesits analogue, the depression which occurs at the site of the 6o6 GEORGE RYERSON FOWLER. internal ring following the completion of the descent of thetesticle. (Diagram B.) The length of time which this takeswill depend upon the support which the external structuresgive to the infundibulum at this point, the amount of intra-abdominal pressure, and the freedom of movements of theintestinal coils as governed by the length of the , however, the depression upon the peritoneal surfacebecomes sufficiently marked to embarrass the convexlyshaped surface of intestine in its movements at this point, theinsidious and constantly exercised force from within the ab- 7rar?syersa//sfac/a Spermaac Cord. Conioined Tenc/or?/ £)//gue ? ? :,- 5Hin Diagram B.—Showing the depression which occurs atthe site of the internal ring, following the completionof the descent of the testicle. domen exerted through this as a wedge, aided by peristalsisand the movements of the intestinal contents, and finally bygravity as the depression becomes more pronounced; withall these predisposing factors brought into play from the peri-toneal side of the abdominal wall, there is but one thing lack-ing to complete the probability of the return of the hernia,—namely, an absence of support from without. This is fur-nished 1)y the still-existing internal ring, the point at whichthe hernia, if an indirect one, protruded originally, and whichthe presence of the cord as it passes forward through the mus- THE RADICAL CURE OF INGUINAL HERNIA. 607 CLilar Structures of the abdominal wall renders necessary, andthe relaxed transversalis fascia at the site of Hesselbachstriangle, if the h
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Keywords: ., bookcentury1800, bookdecade1880, booksubjectsurgery, bookyear1885
