. American practice of surgery ; a complete system of the science and art of surgery . tents, as is observed in ojjerations uponthe larger hernias. It is not to plan any one operative method which, with slight modi-fications, may be adopted for ventral hernias in various parts of the a large proportion of hernias due to post-operative suppuration and character-ized by scars which have formed adhesions in many different directions, I findit much easier to enter the abdomen from one side rather than through the scaror sac. I make an elliptical incision around the vrhole cica
. American practice of surgery ; a complete system of the science and art of surgery . tents, as is observed in ojjerations uponthe larger hernias. It is not to plan any one operative method which, with slight modi-fications, may be adopted for ventral hernias in various parts of the a large proportion of hernias due to post-operative suppuration and character-ized by scars which have formed adhesions in many different directions, I findit much easier to enter the abdomen from one side rather than through the scaror sac. I make an elliptical incision around the vrhole cicatricial area, and then,after the necessary dissection, I remove the entire mass, thus making it possibleto secure a linear wound when the opposite edges are brought together andsutured. After removal has been accomplished I open the abdomen at a pointto one side of the ring. If it be found that the omentum is adherent, the portionwhich is adherent may be freed or cut off. When the bowel is found to be ad-herent to the sac the separation calls for the most careful dissection. Herein. Fig. 244.—Two Different Patterns of Spring Trusses for Use in Umbilical Hernia. lies the advantage of the lateral incision, enabling us to make this dissectionfrom the peritoneal side. In a ventral hernia the sac cannot, if much scar tissueis present, be stripped from the overlying skin as it can in the case of a femoralo-r an inguinal hernia. Rather than attempt this it is safer, after entering theabdomen, to cut around the ring margins a little to one side and allow the sacand overlying cicatrix to be removed in one piece. Of course, some ventralhernias have small rings and bottle-shaped sacs which can be treated by enuclea-tion and ligation at the neck. When the ring is large, the peritoneum shouldbe closed by a line of buried sutures, and, for some distance from the marginsof the ring, it should be undermined or detached, in order to give it elasticityand to favor the plastic work outside. Aft
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectsurgery, bookyear1906
