386 HERNIAL RUPTURE 



Herniotomy is, as a rule, a rather easy operation in the dog. It 

 may be performed in two ways: with or without opening the hernial 

 pouch. The former is especially used in recent eases of hernia with 

 wide orifices and in old cases of hernia wdth extended adhesion of the 

 hernial contents, where the whole mass is firmly fastened together. The 

 latter method of operation is used in cases of hernia which are not com- 

 plicated with a hernial pouch, in strangulated hernia with considci-alile 

 alteration of the contents, or with a very narrow hernial opening. These 

 conditions, however, are only distinguished during the course of the 

 operation, and we are then forced to change from the first to the second 

 method of operation. In both methods the skin of the operated region 

 must be shaved and carefully disinfected. We then lift up a fold of the 

 skin corresponding with the axis and the length of the hernia and split 

 it open with a longitudinal incision. This must be made very carefully 

 until we reach the hernial pouch. This is recognized by its irregular 

 surface, which is of a grayish-yellow color; also by the fact that it is 

 impossible to get an ordinary sound directly into the abdominal cavity, 

 and when the sac is pressed by the fingers, the hernial contents will 

 slip back, if the hernia is an old one, it is whitish-gray in color but if 

 strangulated, it is deep purple-red in color. 



Having carefully dissected out the sac until it is completely sepa- 

 rated from the surrounding tissue, taking care not to injure the contents, 

 we follow one of the two methods before spoken of — that is, not opening 

 or opening the hernial pouch. 



In the former case we introduce by means of the index finger a 

 probe-pointed bistoury or herniotome between the neck of the hernia 

 and its orifice, turning the cutting edge of the knife toward the neck or 

 restricted portion, the dull side of the knife being toward the hernia 

 pouch. By means of a very small incision the tension becomes greatly 

 relaxed, and reduction is easily accomplished. If the opening of the 

 hernial pouch is required, we hold up one of its folds with a pair of forceps 

 and split it by means of a knife held flat or a pair of scissors. After the 

 discharge of the fluids in the hernial sac a notch is cut in the hernial 

 pouch by means of the herniotome. The exposed loop of intestine is 

 reduced by the method just described, by cutting through the constricted 

 portion and working the intestine back in such a way that the portion 

 of the intestine which was prolapsed last must be reduced first. 



If the intestine is much distended by gas, it may be emptied by 

 means of a puncture of a very fine trocar (or the canula of a large hypo- 

 dermic syringe). Any degenerated portions of the epiploon must be 

 amputated after being ligated. If the intestine is intensely inflamed or 

 gangrenous, we must either resect it or make an artificial anus. 



After reducing the hernia we must close the hernial orifice. This is 



