The practice of surgery . ackfrom the underlying conjoined tendon with further gauze will see that the deep parts are now thoroughly exposed down tothe preperitoneal fat. The hernia bulges into the wound, its sac closely INGUINAL HERNIA 207 associated with the coverings of the spermatic cord. The suigeonmust next separate carefully the cord from the sac. One cannot alwaysdo this without tearing apart the structures of the cord, but this makesno difTerence so long as the vas, the arteries (especially the artery of thevas), and two or three good-sized veins are left. The sac is mo
The practice of surgery . ackfrom the underlying conjoined tendon with further gauze will see that the deep parts are now thoroughly exposed down tothe preperitoneal fat. The hernia bulges into the wound, its sac closely INGUINAL HERNIA 207 associated with the coverings of the spermatic cord. The suigeonmust next separate carefully the cord from the sac. One cannot alwaysdo this without tearing apart the structures of the cord, but this makesno difTerence so long as the vas, the arteries (especially the artery of thevas), and two or three good-sized veins are left. The sac is most easilyseparated from the cord by firm gauze dissection, and sometimes thismaneuver is facilitated by opening the sac and holding it up upon theextended fingers inserted within it. The cremaster may be well de-veloped, in which case one may utilize it in closing the abdominal it off and separate its fibers from the sac. Now tip the patientabout 25 degrees into the Trendelenburg position, elevate the sac, and. Fig. 113.—Oblique incision through skin and superficial fascia down to fascia ofthe external oblique muscle. Note the external abdominal ring, made apparent byslight bulging caused by fuU hernial sac (adapted from Scudder). return its contents into the abdominal cavity. Secure the neck of thesac with a stout catgut purse-string suture; cut off the stump and pushit back within the internal ring. The distal end of the sac may bedissected out or left, as you choose. This closure of the peritoneal sacmust be made secure. If the peritoneum is thickened or is overlaidwith fat, I recommend sewing up its opening with a catgut or silkbuttonhole stitch rather than tying it off with a purse-string. Besure also that the sac stump is free from all adhesions, both inside andout, that it may slip well back, freely, into the abdomen. Then to close the abdominal wall—the canal: the problem is un-like other similar problems in abdominal surgery, because the cord is 208 THE
Size: 1567px × 1594px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1910
