. Modern surgery, general and operative. n operation for an enormous hernia a great quantity of omen-tum will require removal, and it may be necessary to resect a considerable pieceof intestine. If we decide to operate upon an enormous hernia, treat the patientsome time before with the object of making him lose flesh. The absorption ofmesenteric fat lessens intra-abdominal pressure. That operation may succeedin such cases is shown by Figs. 816 and 817. In any operation for the radicalcure of inguinal hernia always remember that the bladder may be part of thehernia, and be on the lookout for it
. Modern surgery, general and operative. n operation for an enormous hernia a great quantity of omen-tum will require removal, and it may be necessary to resect a considerable pieceof intestine. If we decide to operate upon an enormous hernia, treat the patientsome time before with the object of making him lose flesh. The absorption ofmesenteric fat lessens intra-abdominal pressure. That operation may succeedin such cases is shown by Figs. 816 and 817. In any operation for the radicalcure of inguinal hernia always remember that the bladder may be part of thehernia, and be on the lookout for it. Eggenbergers table of 6778 hernial opera-tions shows 75 bladder hernise ( i per cent.). As a rule, the bladder is coveredwith cellular fat, which differs in color and consistence from omental fat and fromother fat which may be found about a hernia. The presence of a quantity of ex-traperitoneal fat outside of the sac suggests the adjacency of the bladder andwarns us not to tie off the sac verv high up. It was the authors misfortune on. Fig. 816.—Oblique inguinal hernia of large size (duration, sixteen years). two occasions to open a bladder in operating for inguinal hernia. In each casethe bladder was sutured and both patients recovered. It has been estimatedthat the mortality after this accident, even when the bladder is sutured, isfrom 6 to 16 per cent. Among other possible accidents which may occurduring hernia operations are: injury of an iliac vessel, of a femoral vessel, ofan epigastric vessel, or of the obturator artery. The success of an operation for the radical cure of a hernia depends upon theattainment of primary union. Primary union is favored by thorough clean-liness; by wearing gloves while operating; by cutting the parts with a sharpknife instead of tearing them with a dissector; by removing some fat and anysuperfluous tissue fragments; by tying the stitches firmly, but not tightly (atight stitch causes necrosis and creates a point of least resistance); by c
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