HERNIA 



231 



the sac itself twisted slowh' until it forms a kind .of pedicle, 

 around ^\•hich a ligature of aseptic silk or gut can be placed. 

 The lower portion of the sac is then cut off, and the external 

 \^'oand sutured and treated on aseptic lines. If very much 

 dilated, the inguinal ring should also have several sutures 

 drawn across it. 



In some cases of inguinal hernia, however, the sac has to 



Fig-. 148.— .A. Double Inguinal Hernia fixed in a Suitable Position 

 for Operation. 



be opened and its contents exposed before reduction can be 

 effected. The greatest care must now be used to avoid septic 

 infection. After the organs have been returned, the inguinal 

 canal must be sutured with silk or catgut, a pressure pad of 

 aseptic wadding being applied or not according to discretion. 



Fig. 149. — Hernia Bistoury. 



and the external wound sutured with silkworm gut and 

 covered with iodoform collodion. 



At times it is found necessary to incise the inguinal rmg 

 before the organs can be returned, and for this purpose a 

 special bistoury with only a very small portion of its edge 

 sharpened is cautiously used. At other times some portion 

 of the herniated organs, particularly in the case of omentum 



