Annals of surgery . rnalabdominal ring to a point about 2 cm. above and external tothe internal abdominal ring. The vas deferens and the blood-vessels of the cord are isolated. All but one or two of theveins of the cord arc excised. The sac is carefully isolatedand opened and its contents replaced. A piece of gauze isusually employed to replace and retain the intestines. Withthe division of the abdominal muscles and the ^transversalis fasciathe so-called neck of the sac vanishes. There is no longer a con-striction of the sac. The communication between the sac and theabdominal cavity is sometim
Annals of surgery . rnalabdominal ring to a point about 2 cm. above and external tothe internal abdominal ring. The vas deferens and the blood-vessels of the cord are isolated. All but one or two of theveins of the cord arc excised. The sac is carefully isolatedand opened and its contents replaced. A piece of gauze isusually employed to replace and retain the intestines. Withthe division of the abdominal muscles and the ^transversalis fasciathe so-called neck of the sac vanishes. There is no longer a con-striction of the sac. The communication between the sac and theabdominal cavity is sometimes large enough to admit ones sac having been completely isolated and its contents replaced,the peritoneal cavity is closed by a few fine silk mattress sutures,sometimes by a continuous suture. The sac is cut away close tothe sutures. The cord in its reduced form is raised on a hook 1 Bulletin of the Johns Hopkins Hospital, Vol. I, No. 1; Johns Hopkins Hos-pital Reports, Vol. II, Surgical fasciculus, No. 1 applii .in,.., ..i the sui i m, ial buried sutures. RADICAL CURE OF INGUINAL HERNIA. 545 out of the wound to facilitate the introduction of the six or cij^htdeep mattress sutures which pass through the aponeurosis of theexternal oblique and through the internal oblique and transver-salis muscles and transversalis fascia on the one side, and throughthe transversalis fascia and Pouparts ligament and fibres of theaponeurosis of the external oblique muscle on the other. (SeeFig. 1.) The two outermost of these deep mattress sutures passthrough muscular tissues and the same tissues on both sides ofthe wound. They are the most important stitches, for the trans-planted cord passes out between them. If placed too close to-gether, the circulation of the cord might be imperiled, and if too farapart the hernia might recur. They should, however, be nearenough to each other to grip the cord. (See Fig. 2.) The precisepoint out to which the cord is transplanted depends upon the
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Keywords: ., bookcentury1800, bookdecade1880, booksubjectsurgery, bookyear1885
