. Manual of operative surgery. s over the hernialneck. Expose the upper part of the sac of the hernia. 2. By blunt dissection free the sac from its surroundings and from thespermatic cord, which lies posteriorly. This must be done thoroughly. 3. Reduce the contents of the sac and then open and inspect it. It is oftennecessary to open the sac before the hernia can or ought to be reduced. (Fortreatment of complications see page 592.) 4. Pass the finger outside the sac through the opening in the parietes andseparate the peritoneum (of which the sac is a mere continuation) from theparietes for a s
. Manual of operative surgery. s over the hernialneck. Expose the upper part of the sac of the hernia. 2. By blunt dissection free the sac from its surroundings and from thespermatic cord, which lies posteriorly. This must be done thoroughly. 3. Reduce the contents of the sac and then open and inspect it. It is oftennecessary to open the sac before the hernia can or ought to be reduced. (Fortreatment of complications see page 592.) 4. Pass the finger outside the sac through the opening in the parietes andseparate the peritoneum (of which the sac is a mere continuation) from theparietes for a space of ^^ inch on every side of the opening (Fig. 741). 6o4 HERNIA 5. Should the sac be too voluminous, cut oflf its distal end, which may beremoved or left in the scrotum. Every time it is necessary to make an incisionin the sac the position of the cord should be ascertained. 6. A stitch of chromicized catgut is taken through the distal extremity ofthe sac, which is now hanging loosely throucrh the abdominal wall (Fig. 742),. Fig. 741.—Macewens IIG. 742.—Treatment of sac. Fig, 743.—^lacewens opera-operation. {Esmarck and ) and is there tied. The long end of the suture is passed three or four times fromside to side through the sac, so that when pulled upon it throws the sac intofolds. The loose end of the thread is threaded on a Macewen hernia needle, guided by the finger, is passed up external to the sac through theabdominal opening, and thrust outwards through the whole thickness of thepariet£s (with the exception of peritoneum and skin) (Fig. 742). If the thread is
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