Operative surgery . fat at the lower angle, together with one or two large veins,division of which is painful, so that anesthetization of the panniculus layeris here necessary, or else, as has been done on several occasions, the incisiononly at the upper angle may be carried down to the aponeurosis, which is thenopened in the line of fibers from the external ring, and the ilio-hypogastric 944 OPERATIVE SURGERY and inguinal nerves immediately cocainized with a one-per-cent solution asthey lie under it. After this procedure the lower angle of the incision maybe painlessly carried down to the ext
Operative surgery . fat at the lower angle, together with one or two large veins,division of which is painful, so that anesthetization of the panniculus layeris here necessary, or else, as has been done on several occasions, the incisiononly at the upper angle may be carried down to the aponeurosis, which is thenopened in the line of fibers from the external ring, and the ilio-hypogastric 944 OPERATIVE SURGERY and inguinal nerves immediately cocainized with a one-per-cent solution asthey lie under it. After this procedure the lower angle of the incision maybe painlessly carried down to the external ring, and the remaining inter-columnar fibers of the aponeurotic insertion divided. Reflection of the pillarsof the ring gives the view shown in the accompanying sketch (Fig. 1164).In the Halsted operation at this stage the internal oblique fibers are divided,preliminary cocainization of the edge of the muscle being necessary for the ILIO-HYPOGASTRIC NILIO - INGUINAL N «>f INCISION THROUGH INT. OBLIQUE Fig. 1164.—Operation for the la ore of inguinal hernia under local anaesthesia,Cushings method. reasons given above. Tbere is, under ordinary circumstances, no further needof the anaesthetic, as we are working in an area freed from all combined ilio-iuguinal and genital branch, which has been cocainizedat the outer limit of its exposure, is now reflected to one side or the other,care being taken not to divide it, since this leads apparently to a more orless permanent paralysis of the cremaster, which is to be avoided. I believethe accidental division of this nerve leads to the great relaxation of thescrotum so often seen after hernia and varicocele operations. In the latteroperation, especially, it would be detrimental to the best interests of a suc-cessful result to interfere with the cremasteric function in any way. Theremainder of the operation—the exposure of the sac and cord after a longi-tudinal division of the infundibuliform fascia, the amp
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