THE ABDOMEN. 



389 



Radical Cure of Direct Inguinal Hernia. When the conjoined tendon is 

 sufficiently thick and strong it is brought down and sewed to Poupart' s ligament be- 

 neath and behind the cord, thus closing the hernial opening. When it is very weak and 



Transversalis fascia 



--Cut edge of external oblique 



Internal obligue 



Deep epigastric artery 

 Edge of rectus 



Conjoined tendon 



Insertion of conjoined tendon 

 along the iliopectineal line 



Spine of pubis 



FIG. 401. The conjoined tendon of the internal oblique and transversalis muscles. 



thin, the edge of the rectus muscle is dragged downward and outward and sewed to 

 Poupart' s ligament (Bloodgood), then the conjoined tendon (Fig. 401) is brought 

 down in front of it and sewed to Poupart' s ligament, and the external ring narrowed so 



Transversalis fascia 



External oblique 



Conjoined tendon of 

 internal oblique and 

 transversalis 



Rectus muscle 

 Spine of pubis 



Shelving edge of Pou- 

 part's ligament 



FIG. 402. Radical cure of direct inguinal hernia. The aponeurosis of the external oblique has been divided 

 and drawn back. The conjoined tendon has been drawn upward toward the median line. The transversalis 

 fascia covering the rectus has been incised and the edge of the muscle has been drawn out and down and sewed to 

 the edge of Poupart's ligament (Bloodgood). The operation is completed by sewing the conjoined tendon to 

 Poupart's ligament, replacing the cord on it, and stitching the edges of the external oblique together down to the 

 external ring. 



as to allow room only for the cord to escape (Fig. 402). (The triangular fascia, page 

 377, is too uncertain and insignificant a structure to be considered in inguinal herniae). 



