. Abdominal hernia : its diagnosis and treatment. Sac cut away from testicle, ready to tie with purse-string suture. Should be closer toperitoneal surface than here shown. the inside of the sac as seen in fig. 130.) The neck of sac(really the tunica vaginalis) must be gradually worked away 248 ABDOMINAL HERNIA. from the cord just where the vessels leave it to dip down intothe pelvic cavity, and a ligature is either passed around it, or apurse-string suture is placed from its inside, and it is cut awayfrom the cord and testicle ( figs. 131, 132). If it is now decidedthat the cord is too short t
. Abdominal hernia : its diagnosis and treatment. Sac cut away from testicle, ready to tie with purse-string suture. Should be closer toperitoneal surface than here shown. the inside of the sac as seen in fig. 130.) The neck of sac(really the tunica vaginalis) must be gradually worked away 248 ABDOMINAL HERNIA. from the cord just where the vessels leave it to dip down intothe pelvic cavity, and a ligature is either passed around it, or apurse-string suture is placed from its inside, and it is cut awayfrom the cord and testicle ( figs. 131, 132). If it is now decidedthat the cord is too short to allow of the testicle being placed inthe top of the scrotum, the fingers should be run under theinternal oblique and transversalis muscles towards the medianline, forming a pocket between these structures and the peri-toneum (fig. 133). In this pocket the testicle is then placedand the canal entirely obliterated by closing it according to Fig. Sac tied by purse-string suture. the Bassini method, except that there is no cord to provide closure can be completed, as it is in most cases, in thefemale. In the 7 cases where I have placetl the testicle in this posi-tion, the patients have, in every instance, experienced the mostcomplete comfort. In one doubtful case on the left side, Ifound that the testicle would come well outside of abdominalwall, hut not fully into the scrotum, and I made the mis-take of leaving it in this position instead of placing it underthe muscles as on the other side. It has since been a .sourceof more or less discomfort to the patient. In young chil-dren, the subsequent and further descent of the testicle can COMPLICATIONS IN SURGICAL CURE. 249 Intemanoblique!and trans- fV e r s a I i s j
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