British medical journal . dsright through the reflected aponeurosis—the lower oneembracing in transit some fibres of Gimbernats ligament(Iig. 2)—passed across the floor of triangle,and made to emerge through the substance of the conjointtendon. The needle is now threaded with strong catgut,one end grasped by an assistant, and the needle with-drawn. The unthreaded needle is again similarly intro-duced about half an inch above the former, and a mattresssuture completed. Three more similar ones are insertedthrough the above level, and sufficient room is left at theupper angle for the
British medical journal . dsright through the reflected aponeurosis—the lower oneembracing in transit some fibres of Gimbernats ligament(Iig. 2)—passed across the floor of triangle,and made to emerge through the substance of the conjointtendon. The needle is now threaded with strong catgut,one end grasped by an assistant, and the needle with-drawn. The unthreaded needle is again similarly intro-duced about half an inch above the former, and a mattresssuture completed. Three more similar ones are insertedthrough the above level, and sufficient room is left at theupper angle for the passage of the cord (.Fig. 1). Ii6 XJK.^jIIA with rXUSUAL UREA RETENTION. [July iS, 1914 When these fouv sutures are tic-l (Fig. 3), the anatomyof the part i? considerably traHsfoimed, the inner shelf ofPouparfs ligameHt being tirmly approxiiuatecl to theconjoint tendon. Hesselbachs triangle is completelyobliterated. In some patients, with ill-developed or Hahbyconjoint tendons, I have obtained benclit by passing the. Via. of first stiteli through Ciimheriiafs ligauieubaud coujoiued teuflon. A. Pouparts ligameut. n. Conjoined ;, Covtl retracted inwar<ls. E, Esterual oblique. lieruia needle further inwards through the adjoiningsheath of the rectus, so as to afford a good purchasefor the loop of the mattress suture. Finally, the two aponeurotic leaves arc united by acontinuous catgut suture, and in doing this I make it aXule to insert the point of the needle deep enough to catclihold of underljing muscle in order that no intermusculardead space may be left. The cord, of course, is left, as inHalsteds operation, superficial to the external oblique.
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Keywords: ., bookcentury1800, bookdecade1850, booksubjectmedicine, bookyear185
