Operative surgery . and the transversalis fascia, to a point about an inchabove the internal abdominal ring (Fig. 1134); isolate the vas deferens andthe blood vessels of the cord (Fig. 1135), and excise all the veins but oneor two (Fig. llofi); isolate and open the sac and return the contents tothe abdominal cavity; detach thoroughly the upper end of the sac and closeit with mattress or continuous sewing with silk, and cut off the sac closeto the sutures; raise the cord up-ward and out of the way and in-troduce six or eight silver-wiremattress sutures through the apo- i eurosis of the external
Operative surgery . and the transversalis fascia, to a point about an inchabove the internal abdominal ring (Fig. 1134); isolate the vas deferens andthe blood vessels of the cord (Fig. 1135), and excise all the veins but oneor two (Fig. llofi); isolate and open the sac and return the contents tothe abdominal cavity; detach thoroughly the upper end of the sac and closeit with mattress or continuous sewing with silk, and cut off the sac closeto the sutures; raise the cord up-ward and out of the way and in-troduce six or eight silver-wiremattress sutures through the apo- i eurosis of the external oblique, \ the muscular fibers of the internal \ ?-?-,, oblique and transversalis, and the I ??•..._ transversalis fascia, at the upper \ ?? side and through the transversalis ^•/^?•-^c fascia, Pouparts ligament, andthe aponeurosis of the externaloblique at the lower side of thewwmd (Fig. 1137). The twooutermost sutures pass throughmuscular tissue at both sides ofthe wound andbetween .f-ycv. themthe cord is permittedto escape; tie the su-tures so as to bringthe tissues snugly to-gether (Fig. 1138),unite the borders ofthe aponeurosis of theexternal oblique mus-cle with silver - wiremattress sutures (), and close theskin wound with a fine continuous subcuticular silver-wire suture (Fig. 1140).The Remarks.—In this operation a new canal and internal ring areformed, the latter fitting the cord snugly. During the closure of the base ofthe sac by sewing the intestine is retained in place with gauze or a string-attached sponge, and as the sewing progresses the sac can be severed, thus Fig. 1133.—Operation for the radical cure of inguinal hernia,Halsteds method. An anterior superior, spinous incision, exposure of external abdominal ring andthe cord; line of division of aponeurosis of externaloblicjue muscle (dotted line). 920 OPERATIVE SURGERY. maintaining better control of the peritoneal borders of the opening. Therestraining agent should be withdrawn
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Keywords: ., bo, bookcentury1800, bookdecade1890, bookidoperativesurgery02brya
