. Modern surgery, general and operative. hernia. They are more commonin an adult. Cheyne ligates the neck of the sac, stitches the stump to the ab-dominal wall, dissects out a flap from the pectineus muscle, stitches this flap toPouparts ligament and to the abdominal wall, and thus fills up the crural makes an incision parallel to Pouparts ligament, ties the neck of thesac, cuts off the sac below the ligature, and returns the stump into the attaches by deep sutures Pouparts ligament to the pectineal aponeurosisjis high up as the pectineal eminence, the cord or round liga
. Modern surgery, general and operative. hernia. They are more commonin an adult. Cheyne ligates the neck of the sac, stitches the stump to the ab-dominal wall, dissects out a flap from the pectineus muscle, stitches this flap toPouparts ligament and to the abdominal wall, and thus fills up the crural makes an incision parallel to Pouparts ligament, ties the neck of thesac, cuts off the sac below the ligature, and returns the stump into the attaches by deep sutures Pouparts ligament to the pectineal aponeurosisjis high up as the pectineal eminence, the cord or round ligament being drawnout of the way. Superficial sutures are passed between the pubic portion andthe iliac portion of the fascia lata. The operation of Fahricius is performed as follows: An incision is begunover the pubic spine and is carried outward for 5 inches parallel with Poupartsligament. The sac is exposed, isolated, and opened, its contents are reduced,its neck is ligated, the sac is cut off, and the stump is dropped back (Fig. 839).. ?f <y Fig. 830 I;il)ri(iuss operation for the radical cufl of fcmcjral hernia: .Wck of sac shown. Sac cut away.(Fowler). DuUed line shows line of separation of Pouparts ligament and fascia lata An incision is now made below Pouparts ligament so as to separate this struc-ture and the fascia lata, and the flap of fascia is turned down (Fig. 840). Thecrural sheath and the vessels are retracted outward. The surgeon is carefulnot to injure the obturator artery and vein. The origin of the pectineus muscleis sutured to Pouparts ligament. The lower stitches include the periosteumof the horizontal ramus of the pubes as well as the beginning of the muscle(Fig. 841). Care must be taken in passing certain of them to avoid injuringthe deep epigastric vessels. When these stitches are tied, the femoral canalis obliterated. The flap of fascia lata is sutured to the aponeurosis of the ex-ternal oblique, and the skin is sutured. The best operation is that of
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