. Abdominal hernia : its diagnosis and treatment. Showinjj relalive position of sac, curd and vas delereiis ; ul handling. {HafsUd ) relaxation cuts determined. A second reason for postponingrelaxation incisions into the anterior sheath of the rectus muscleis that we sometimes use this portion of the rectus sheath toclose the lower part of the inguinal canal, as already stated. ( 4) When the \eins are large, and this is usually the 230 ABDOMINAL HERNU. case, they should be excised with very great care to avoid eventhe slightest extravasation of blood into the tissues about thesmaller
. Abdominal hernia : its diagnosis and treatment. Showinjj relalive position of sac, curd and vas delereiis ; ul handling. {HafsUd ) relaxation cuts determined. A second reason for postponingrelaxation incisions into the anterior sheath of the rectus muscleis that we sometimes use this portion of the rectus sheath toclose the lower part of the inguinal canal, as already stated. ( 4) When the \eins are large, and this is usually the 230 ABDOMINAL HERNU. case, they should be excised with very great care to avoid eventhe slightest extravasation of blood into the tissues about thesmaller veins and about the vas deferens which they accom-pany. And the vas deferens, as first emphasized by Blood-good, should not be raised from its bed or handled or eventouched, lest thrombosis of its veins occur (fig. 113). The Fig. Showing Ih tid uiiJtr 111- ubliquo muscle by fine siik sutures.(Haisled.) veins should be ligated as high up in the abdomen as pos-sible, being ])ulled down quite firnily just before the ligature(in a needle with blunt end first) is passed between a precaution against slipping, we apply two ligatures offine silk, both for the abdominal stump and for the testiclestump of the veins. The farther from the testicle the \eins aredivided, the better, pnnided. of course, that their stump isexternal to the external abdominal ring. SURGICAL CURE. 231 (5) Ligation of the sac by transfixion or by purse-stringsuture at the highest possible point. Both ends of this suture,after tying, are threaded on long curved needles, then carriedfar out under the internal oblique muscles from behind for-wards, and, passing through the muscle, about 5 mm. tied. The idea was suggested to the author by Kochersoperation, the principle being essentially the same. Fig. 115-
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