. Operative surgery, for students and practitioners . nthe inguinal canal; or external to the inguinal canal, underneath theskin. In connection with this condition there is almost always asso-ciated a patent vaginal process and therefore a condition of congenitalhernia either actual or latent. Bevan advises that the time to operateis between the ages of six and twelve years. An incision three inches long is made from a point half an inchabove the middle of Pouparts ligament to the base of the incision divides the integument and the aponeurosis of the ex-ternal oblique. The edges of
. Operative surgery, for students and practitioners . nthe inguinal canal; or external to the inguinal canal, underneath theskin. In connection with this condition there is almost always asso-ciated a patent vaginal process and therefore a condition of congenitalhernia either actual or latent. Bevan advises that the time to operateis between the ages of six and twelve years. An incision three inches long is made from a point half an inchabove the middle of Pouparts ligament to the base of the incision divides the integument and the aponeurosis of the ex-ternal oblique. The edges of the aponeurosis are seized with arteryforceps and well retracted, thus exposing the cremasteric fascia, whichfills in the space between the lower edge of the internal oblique muscle(conjoined tendon) and Pouparts ligament (see Fig. 195). Thislayer of fascia is incised together with the underlying fascia transver-salis, and there is then exposed to view the peritoneal pouch or sacwithin which the testis is situated. When this peritoneal pouch or sac. Fig. 194.—Operation for Femoral Hernia. FY, femoral vein. Poupartsligament has been sutured to the upper part of the fascia that covers thepectineus muscle. OPERATIONS FOR HERNIA. 453 is incised the testicle is exposed and the operator finds himself withinthe vaginal process (tunica vaginalis), which is found, as a rule, tocommunicate direct with the peritoneal cavity (see Fig. 196). The vaginal process of peritoneum (the peritoneal pouch con-taining the testicle) is now divided just above the testicle and theupper portion of it peeled upward away from the structures that goto make up the spermatic cord and which lie beneath it; it is thentransfixed with the needle and tied high up with a catgut portion of the sac should be tied upon the point of the fingerplaced within it, just as in tying off an ordinary hernia sac so as notto include a process of gut or omentum which might have entered purse-string suture is
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