The practice of surgery . by tying or suturing and cutting off the sac, and drop- 206 THE ABDOMEN ping the stump well within the peritoneal eavity at a point not weakenedby the past^age of the cord, if possible. We transplant the cord, orbring it out through a new opening without transplanting it. Bearing inmind that the prime cause of weakness in the inguinal region is the lackof attachment of the conjoined tendon to Pouparts licjanient in its innerhalf, we make good the defect by stitching the conjoined tendon tothat inner half of Pouparts ligament and to Ciimbernats ligament—we attempt to i
The practice of surgery . by tying or suturing and cutting off the sac, and drop- 206 THE ABDOMEN ping the stump well within the peritoneal eavity at a point not weakenedby the past^age of the cord, if possible. We transplant the cord, orbring it out through a new opening without transplanting it. Bearing inmind that the prime cause of weakness in the inguinal region is the lackof attachment of the conjoined tendon to Pouparts licjanient in its innerhalf, we make good the defect by stitching the conjoined tendon tothat inner half of Pouparts ligament and to Ciimbernats ligament—we attempt to improve on nature. Method—Oblique Inguinal Hernia.—The patient is put to bed fora couple of days before operation and the bowels thoroughly evacuatedby castor oil and enemata. An oblique incision is made 5 or 6 incheslong, from the pubic spine upward and outward over the course ofthe canal, as far as the anterior-superior spine of the ilium, parallel toand two fingerbreadths from Pouparts ligament. The external ring. Fig. 112.—Incision for cure of inguinal hernia. quickly is developed with the knife and with gauze dissection, and allbleeding points are secured, that their oozing may not obscure andsoil the deeper field nor favor subsequent infection. For a space ofabout 3 inches around the incision the superficial tissues are sweptback by a gauze wipe, so as thoroughly to expose the aponeurosis .ofthe external oblique. This maneuver greatly facilitates the subsequenthandling of that aponeurosis. The inguinal canal is then slit up withscissors, thus dividing thoroughly the external oblique and exposingthe deeper parts. In doing this avoid the two nerves of the region.(Some surgeons prefer to open the external oblique aponeurosis halfan inch above and to the inner side of the canal.) The edges of theopened aponeurosis are now seized, firmly retracted, and turned backfrom the underlying conjoined tendon with further gauze will see that the deep parts are now
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1910
