. A manual of operative surgery . it is to be brought through the small openingmuscles. , External oblique; Ep. v., Deep epigastric vessels; spermatic cord is not shown for the sake of clearness. Conjoined neck and tied with the Staffordshire knot. The ends are cutshort, and the stump left to itself. 2. The sac being ligatured in the manner described, each endof the ligature is successively threaded on a mounted needlewith its eye close to the point. Guided by the left index finger chap, xii] RADICAL CURE OF INGUINAL HERNIA 343 the needle is made to transfix the transversalis and ob
. A manual of operative surgery . it is to be brought through the small openingmuscles. , External oblique; Ep. v., Deep epigastric vessels; spermatic cord is not shown for the sake of clearness. Conjoined neck and tied with the Staffordshire knot. The ends are cutshort, and the stump left to itself. 2. The sac being ligatured in the manner described, each endof the ligature is successively threaded on a mounted needlewith its eye close to the point. Guided by the left index finger chap, xii] RADICAL CURE OF INGUINAL HERNIA 343 the needle is made to transfix the transversalis and obliquemuscles at two adjacent points at least an inch above and tothe outer side of the internal ring. The threads, being drawnthrough on the superficial aspect of the muscles, are now tiedtogether so as to fix the stump away from the inguinal will be understood that the stump of peritoneum is not itselfdrawn through the abdominal wall, but simply anchored behindthe latter well away from the site of its former FIG. 98.—RADICAL CURE OF INGUINAL HERNIA. , Pouparts ligament; c, Spermatic cord. The stump of the sac (s) has been twisted andbrought through a small opening made in the muscles, where it is fixed by two deepsutures which are shown not yet secured. The dotted area w indicates the thin portionof external oblique aponeurosis which is divided when the canal is opened up. 3. The sac is held by pressure forceps and twisted on its longaxis several times. The left index finger is passed upwardsalong the canal under the oblique and transversalis muscles anda small incision made over its tip so as to allow a pair of forcepsto be introduced from without inwards. The forceps are thenopened and made to grasp the twisted sac, which is now drawnthrough the opening and securely fixed there by tendon stitcheswhich maintain the torsion (Fig. 98). It will be understoodthat the opening is placed well to the outer side and above theinternal ring, that it is compl
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