. Operative surgery, for students and practitioners . f the operation, the approximation of the cut edges of theseveral layers of the abdominal wall. While this is being accom-plished the cord is raised upon a hook and held out of the way,- welltoward the outer part of the incision. To unite these parts from sixto eight mattress sutures of silk are required. The layers which areapproximated consist above of the aponeurosis of the externaloblique, the internal oblique and the transversalis muscles (con-joined tendon), and the transversalis fascia. Below they consist ofPouparts ligament and the
. Operative surgery, for students and practitioners . f the operation, the approximation of the cut edges of theseveral layers of the abdominal wall. While this is being accom-plished the cord is raised upon a hook and held out of the way,- welltoward the outer part of the incision. To unite these parts from sixto eight mattress sutures of silk are required. The layers which areapproximated consist above of the aponeurosis of the externaloblique, the internal oblique and the transversalis muscles (con-joined tendon), and the transversalis fascia. Below they consist ofPouparts ligament and the aponeurosis of the external oblique andthe transversalis fascia, and in part, externally, of the cut edges ofthe internal oblique and transversalis muscles. The sutures pass 450 HERNIA, ETC. through all these layers. Between the two most external of thesesutures the cord emerges through the abdominal wall, between the cutedges of the internal oblique and transversalis muscles. The cordshould be firmly grasped by these muscles, but not tightly enough. Fig. 193.—Halsteds Operation. The vas deferens, with a few remainingvessels of the cord, drawn aside with a hook. Mattress sutures have beenapplied, uniting the different layers that have been cut, including the apo-neurosis of the external oblique. to strangle it. The cord, as it emerges through the abdominal wall,in its new position, should be surrounded by the fleshy fibers of thesemuscles; it should not emerge between the tendinous portions ofthe muscles. If the incision through the internal oblique and trans- OPERATIONS FOR HERNIA. 451 versalis muscles and the transversalis fascia has not been carriedsufficiently far, in a direction upward and outward, to accomplishthis, it should be extended farther, so as to reach well into the fleshyportion of these muscles. After the mattress sutures have been applied and the parts al-ready mentioned approximated, the cord is dropped back into thewound and rests upon the aponeurosis of t
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