. Manual of operative surgery. Fig. 738.—{Dujaricr.)F. Poupartsligament. Coopers ligament. H. Neck of sac ligated. If the difficulty in reduction is due to adhesion of the sac to the tissues ofScarpas triangle, dissect the sac free from these adhesions or if this is toodifficult, divide the sac as close as possible to the adhesions leaving the adherentportion of the sac buried in Scarpas triangle and treating the mobilized sacsecundum arlem. B. If the sac has contents which are reducible, reduce them and treat thesac as in .4. FEMORAL HERNIA 601 If the contents are not reducible or are st
. Manual of operative surgery. Fig. 738.—{Dujaricr.)F. Poupartsligament. Coopers ligament. H. Neck of sac ligated. If the difficulty in reduction is due to adhesion of the sac to the tissues ofScarpas triangle, dissect the sac free from these adhesions or if this is toodifficult, divide the sac as close as possible to the adhesions leaving the adherentportion of the sac buried in Scarpas triangle and treating the mobilized sacsecundum arlem. B. If the sac has contents which are reducible, reduce them and treat thesac as in .4. FEMORAL HERNIA 601 If the contents are not reducible or are strangulated treat them according tothe rules laid down on page 592. Dislocate the sac into the inguinal canal. ^Igp 3.—By traction on the sac try to pull forwards as much peritoneum aspossible from above the neck of the sac. Note that the bladder is liable to bedragged into the wound. Ligate the sac as high up as possible (Fig. 738)and cut it awav distal to the Coopers ligament. Fig. F. Pouparts ligament. -\ Dujaricr.) Internal oblique and transversalis. C. Cord. Step 4.—Closure of the femoral canal. Insert two or more suturesthrough the fascia covering the horizontal ramus of the pubes just internal to thefemoral vein fFig. 739). Pass the lower end of each of these sutures through thedeep part of Pouparts ligament and the upper end through the internal obhqueand transversalis. The spermatic cord lies behind these sutures. When 6o2 HERNIA these sutures are tied the femoral canal and the deep part of the inguinalcanal are closed. Reich (Beitr. z. klin. chir., Ixxiii, iioj closes the inguinalby suturing the internal oblique and transversalis to Coopers ligament and thepubic periosteum without including Pouparts ligament. Thus the cord lies infront of the sutures. Step 5.—Suture the wound in the external oblique. Suture the skin. Seelig and Tuholske (Surg., Gyn. and Obst., xviii, page 58) describe anoperation almost the same
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