1200 THE SURGICAL ANATOMY OF HERNIA. 



extreme difficulty of detecting the existence of the swelling, especially in corpulent 

 subjects. The coverings of an incomplete femoral hernia would be, from without 

 inward, integument, superficial fascia, falciform process of fascia lata, crural 

 sheath, septum crurale, subserous areolar tissue, and peritoneum. When, however, 

 the hernial tumor protrudes through the saphenous opening and directs itself 

 forward and upward, it forms a complete femoral hernia. Occasionally the hernial 

 sac descends on the iliac side of the femoral vessels or in front of these vessels, or 

 even sometimes behind them. 



The seat of stricture of a femoral hernia varies : it may be in the peritoneum 

 at the neck of the hernial sac ; in the greater number of cases it would appear to 

 be at the point of junction of the falciform process of the fascia lata with the 

 lunated edge of Gimbernat's ligament, or at the margin of the saphenous opening 

 in the thigh. The stricture should in every case be divided in a direction upward 

 and inward, and the extent necessary in the majority of cases is about two or 

 three lines. By these means all vessels or other structures of importance in 

 relation with the neck of the hernial sac will be avoided. 



