Buffalo medical and surgical journal . Fig. 2. but I prefer the former, as the time for absorption is longer, andthe sutures are stronger in proportion to their size. From fourto six interrupted sutures will be sufficient to make a firmposterior wall for the cord structures, care being taken not toconstrict them at the internal ring. Thirdly, the obliquity is reestablished by bringing togetherthe flaps of the external oblique, by a continuous suture of thesame material. The skin wound is closed with interrupted catgutwithout drainage. Kochers method simply deals with the sac, which is dissecte
Buffalo medical and surgical journal . Fig. 2. but I prefer the former, as the time for absorption is longer, andthe sutures are stronger in proportion to their size. From fourto six interrupted sutures will be sufficient to make a firmposterior wall for the cord structures, care being taken not toconstrict them at the internal ring. Thirdly, the obliquity is reestablished by bringing togetherthe flaps of the external oblique, by a continuous suture of thesame material. The skin wound is closed with interrupted catgutwithout drainage. Kochers method simply deals with the sac, which is dissectedout as thoroughly as possible, without slitting up the canal, and MILLIKEN : RADICAL CURE OF INGUINAL HERNIA. 149 pulled through a small opening, which he makes in the aponeu-rosis of the external oblique, opposite the internal. He after-wards sutures it to the aponeurosis, over the canal, but in so doingonly strengthens the outer Fig. 3. Halsteds method is simply the transplantation of the cordwithout any particular endeavor to rebuild the canal. Afterdividing the external oblique, he lifts out the cord structures, andties off the sac ; then sutures the respective tendons together,posterior to them, allowing them to come out directly instead ofobliquely. Although I have never met with any recurrences fromthis operation, possibly owing to its being rarely employed inNew York, I am confident that, sooner or later, a hernia willdevelop at the point of exit of the cord structures. Anotherdecided objection to this procedure is the liability to adhesionswith the overlying fascia, which will not occur when they passbetween the serous covered tendons. 150 CLINICAL REPORT. Of something over thirty cases, operated upon by me after themethod of Bassini, I have had three recurrences. In each, suppur-ation occurred, and the hernia made its appearance during thefirst six months. conclusions. 1. Reconstruction is the best me
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