File:Manual of operative surgery (1921) (14784568275).jpg

Identifier: manualofoperativ1921binn (find matches)
Title: Manual of operative surgery
Year: 1921 (1920s)
Authors: Binnie, John Fairbairn, 1863-1936
Subjects: Surgery, Operative
Publisher: Philadelphia : Blakiston
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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in the Johns HopkinsHospital. It is based on the original operation of Halsted, modified by him-self and Bloodgood. (Johns Hopkins Bulletin, August, 1903.; Step I.—Divide the skin and the aponeurosis of the external obhque asin the Bassini operation. Reflect the aponeurotic flaps. Step 2.—Split the cremaster muscle and fascia along a line a little abovethe centre of the cord. INGUINAL HERNIA 6ii Step 3.—Expose clearly the internal oblique muscle beside the canal. Step 4.—Examine the hernia and the cord. If the veins are large, andthis is usually the case, excise them with very great care to avoid even theslightest extravasation of blood into the tissues about the smaller veins andabout the vas deferens which they accompany. Do not raise the vas deferensfrom its bed; do not handle or even touch it, if possible, lest thrombosis ofits veins occur (Fig. 754). Ligate the veins as high up in the abdomen aspossible, pulling them quite firmly just before the ligature (in a needle with
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Fig. 753.—(A. H. Ferguson.) the blunt end first) is passed between them. Ligate the lower portions ofthe veins at a point as high above the testicle as possible, the stump being,of course, outside the external abdominal ring. Step 5.—^Ligate the sac by transfixion or purse-string suture at the highestpossible point. After tying this suture thread its ends on long curved needlesand pass them outwards under the internal oblique muscle to penetrate themuscle from within outwards at two points about 5 mm. (^^ inch) apart. Tiethe ligatures. This step dislocates the neck of the sac in a manner essentiallythe same as is recommended by Kocher. Step 6.—Draw the lower flap of cremaster muscle and fascia up under the 6l2 HERNIA k..., flffi m Fig. 754.—(Halsted.)

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