. Operative gynecology. iples of the operation are the same as in the operation fora hernia in the linea alba, making the necessary changes to adapt the steps to thealtered anatomical conditions. There are two ways of getting at an inguinal hernia : first, in those cases inM^hich the hernia exists as a complication of some other abdominal affection 482 THE RADICAL CUKE OF HERNIA. wliieh needs celiotomy, the easiest way to reach it is, after the abdomenhas been opened, to introduce two fingers of the left hand, and to locate theposition of the hernia either by the exit of the round ligament thr
. Operative gynecology. iples of the operation are the same as in the operation fora hernia in the linea alba, making the necessary changes to adapt the steps to thealtered anatomical conditions. There are two ways of getting at an inguinal hernia : first, in those cases inM^hich the hernia exists as a complication of some other abdominal affection 482 THE RADICAL CUKE OF HERNIA. wliieh needs celiotomy, the easiest way to reach it is, after the abdomenhas been opened, to introduce two fingers of the left hand, and to locate theposition of the hernia either by the exit of the round ligament through thewall, or by the weak spot readily felt above Pouparts ligament; the thinned-out inguinal canal is pushed forward with the fingers until it makes a decidedpromiuence on the skin surface. Taking the scalpel in the other hand, theoperator now cuts down through the , skin, subcutaneous fat, aponeu- rosis of the external obhque muscle f 1 into the canal, the fingerswithin saving the deeper structures /;| from Fig. 551.—Fifth Step. Shows the closure of the inguinal canal with silver-wire mattress sutures and the disposition of the roundligament, which is brought out between the first and second sutures directly under the skin and subcuta-neous fat. The internal oblique and the trausversalis muscles are seen along the upper margin of the suture transfixes the aponeurosis of the external oblique and the internal oblique and trausversalismuscles above and Pouparts ligament below. The loops of the sutures are pocketed, especially the lowerones, where the tension is greater. The round ligament is not detached more than is necessary. Sutures are then introduced in the manner to be described. If the herniasac is small there is no necessity of excising it, as the operation will be qnite aseffective without this step. The method elaborated by Halsted {Johns liopk. Hosp. BuL, vol. i, Dec, 1889 ; The Radical Cure of Hernia) and Bassini {Arch. f. Min. Chir., Bd. xl,
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectgenitaldiseasesfemal
