. Abdominal hernia : its diagnosis and treatment. lowed in the ^^^est. My own experience withit would not lead me to adopt it as a routine method. Hegives the steps of his operation of transverse overlapping ofthe abdominal wall as follows (Jour. , July 25, 1903) :(i) Transverse elliptical incisions are made surrounding theumbilicus and hernia; this is deepened to the base of thehernial protrusion. (2) The surfaces of the aponeurotic structures are care-fully cleared two and a half to three inches in all directionsfrom the neck of the sac (fig. 209). (3) The fibrous and peritoneal coveri
. Abdominal hernia : its diagnosis and treatment. lowed in the ^^^est. My own experience withit would not lead me to adopt it as a routine method. Hegives the steps of his operation of transverse overlapping ofthe abdominal wall as follows (Jour. , July 25, 1903) :(i) Transverse elliptical incisions are made surrounding theumbilicus and hernia; this is deepened to the base of thehernial protrusion. (2) The surfaces of the aponeurotic structures are care-fully cleared two and a half to three inches in all directionsfrom the neck of the sac (fig. 209). (3) The fibrous and peritoneal coverings of the hernia aredivided in a circular manner at the neck, exposing its intestinal viscera are present, the adhesions are separated 378 ABDOMINAL HERNIA. and restitution made. The contained omentum is ligated andremoved with the entire sac of the hernia, and without tediousdissection of the adherent omentum. (4) An incision is made through the aponeurotic andperitoneal structures of the ring, extending one inch or less Fig . Transverse elliptic incision to aponeurosis, and circular division of sac neck. {Majo.) transversely to each side, and the peritoneum is separated fromthe under surface of the uj^per of the two flaps thus formed. (5) Beginning from two to two and one-half inches fromthe margin of the upper flap, three to four mattress .sutures ofsilk or other permanent material are introduced, the loop firmlygrasping the upper margin of the lower flap: sufficient tractionis made on these sutures to enable peritoneal approximation SURGICAL CURE: UMBILICAL. 379 with running suture of catgut. The mattress sutures are thendrawn into position, sHding the entire lower flap into the pocketpreviously formed between the aponeurosis and the peritoneumabove (fig. 2x0). Fig. 210.
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