Modern surgery, general and operative . to theaponeurosis of the external oblique, and the flap, with its fat and fascia, isturned downward and outward (Figs. 749 and 750). The next step is to incisethe external abdominal ring to the intercolumnar fascia and separate thelongitudinal fibers of the external oblique over the inguinal canal to beyond theinternal ring, at a point nearly opposite the anterior superior spine of the transverse fibers that may be encountered are severed. The separatedaponeurosis of the external oblique muscle is then retracted. One has then1 Annals of Surgery
Modern surgery, general and operative . to theaponeurosis of the external oblique, and the flap, with its fat and fascia, isturned downward and outward (Figs. 749 and 750). The next step is to incisethe external abdominal ring to the intercolumnar fascia and separate thelongitudinal fibers of the external oblique over the inguinal canal to beyond theinternal ring, at a point nearly opposite the anterior superior spine of the transverse fibers that may be encountered are severed. The separatedaponeurosis of the external oblique muscle is then retracted. One has then1 Annals of Surgery, Nov., 1897. Treatment of Reducible Hernia 1147 brought into view the contents of the inguinal canal, the hernial sac and itsadhesions, the spermatic cord, the ilio-inguinal nerve, the internal abdominalring, the subserous fat, the cremaster muscle, the conjoined tendon, the internalobhque and its deficient origin at Pouparts ligament, the transversahs fasciaand the internal surface of Pouparts ligament. The sac is now dissected from. Fig. 749—Ferguson s operation: The semilunar Fig. 750.—Fergusons operation: Flap turnedskm incision ( Jour. Am. Med. Assoc). back exposing the aponeurosis and the sac of the hernia (Jour. Am. Med. Assoc). the cord and the internal ring. It is opened and its contents are inspected andproperly dealt with. It is tied high up and cut off, and the stump is droppedinto the abdomen (Fig. 751). If the sac is congenital it is divided into twoparts: the distal portion is used to make a tunic for the testicle and the proximal
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