. Annals of surgery . cially in old hernise, the transversalis fascia is distinctlythickened, and its suture alone holds back the protrusion and practically curesthe hernia, as I have often demonstrated, l)y permitting the patient to coughor strain, before beginning the first true hernioplasty suture of the internal 51 DeWITT stetten oblique muscle and conjoined tendon to Poujjarts. When the cord is drawnout, a small indirect sac is often found coexistent with the direct hernia. Thisis usually an artifact due to the traction on the cord and it is merely dis-sected away from the cord, stripjied
. Annals of surgery . cially in old hernise, the transversalis fascia is distinctlythickened, and its suture alone holds back the protrusion and practically curesthe hernia, as I have often demonstrated, l)y permitting the patient to coughor strain, before beginning the first true hernioplasty suture of the internal 51 DeWITT stetten oblique muscle and conjoined tendon to Poujjarts. When the cord is drawnout, a small indirect sac is often found coexistent with the direct hernia. Thisis usually an artifact due to the traction on the cord and it is merely dis-sected away from the cord, stripjied and pushed hack without opening theperitoneal cavity or, if large enough, it is ligatetl and resected (Figs, iand 2). If a typical indirect sac is found, transfixion, ligation and resectionmust be made as high up as possible, as it is now generally conceded that theproper disposition of the sac is most essential toward the permanent radicalcure. The sac is only deliberately o]iened prior to its removal if it contains. Fig. 4.—Interrupted suture of internal oblique muscle and conjoined tendon toPouparts ligament has been completed. Edge of muscle and tendon are tucked underligament. Two sutures, between which inguinal branch of ilioinguinal nerve emerges, areplaced lateral to exit of cord. First or most medial suture is left long as guide for nextsuture layer. irreducible contents or if, in a right-sided hernia, an appendectomy is to bedone. If the ring is very large, the sac is resected and the peritoneal openingclosed with a continuous No. i chromic catgut suture, which includes the trans-versalis fascia. The method of suture has Ijeen slightly modified since the first already stated, a continuous No. i chromic catgut suture is used for thetransversalis fascia suture, and for closing or inverting the direct sac. Thenan interrupted No. 2 chromic catgut suture line is used for the Bassini sutureof the internal oblique muscle and conjoined tendon to Pouparts. It
Size: 1856px × 1347px
Photo credit: © Reading Room 2020 / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1800, bookdecade1880, booksubjectsurgery, bookyear1885
