Operative surgery, for students and practitioners . crural ring or else it descends closeto the inner wall of the femoral vein and behind the outer border ofthe crural ring. OPERATIONS FOR HERNIA. Hemiotomy.—Incision of the coverings of a hernia, openinginto the sac, and the division of constricting rings or bands constitutethe operation of herniotomy. The operation is done for the purposeof liberating a strangulated hernia. The constriction may be causedby bands in the body of the sac or by the neck of the sac itself, but in 616 HERNIA, ETC. most cases it is probably caused by the firm, unyie
Operative surgery, for students and practitioners . crural ring or else it descends closeto the inner wall of the femoral vein and behind the outer border ofthe crural ring. OPERATIONS FOR HERNIA. Hemiotomy.—Incision of the coverings of a hernia, openinginto the sac, and the division of constricting rings or bands constitutethe operation of herniotomy. The operation is done for the purposeof liberating a strangulated hernia. The constriction may be causedby bands in the body of the sac or by the neck of the sac itself, but in 616 HERNIA, ETC. most cases it is probably caused by the firm, unyielding ring by whiclithe neck of the sac is encircled. At one of the usual sites of a hernial protrusion there is found atense, elastic tumor. The incision is placed over the most prominentpart of the tumor, cutting carefully through the skin and the deeperlayers until the sac proper is reached. The sac may then be pinchedup with two forceps and incised between them, when there is anescape of serous fluid, and the contents of the sac are Fig. 277.—Irregular Origin of Obturator Artery. In its course into the pelvisit lies close to the inner side of the femoral vein. A, femoral artery; E, deepepigastric artery; GL, Gimbernats ligament; IR, internal inguinal ring; 0,obturator artery; PL, Pouparts ligament; Y, femoral vein. The space betweenthe femoral vein and Gimbernats ligament is known as the crural ring, andthrough this femoral hernia leaves the abdomen. The contents vary; they may consist of intestine, large or small;of omentum, or of both; and occasionally there may be other organs,such as the bladder, ovary, etc. After the sac has been freelyopened, its contents should be examined. Any constricting bands inthe body of the sac should be divided, and an attempt then made topull the gut down so as to ease it at the point of constriction; butin this effort much force should not be used. An effort is made to OPERATIONS FOR HERNIA. 617 insert the finger into the neck
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