INGUINAL HERNIA. 1 1 i 



With an Abdominal Hernia an incision is carefully made 

 down to the protruding organs, which are returned by gentle 

 pressure, the muscles being lightly scraped at the edges and 

 sutured with silkworm gut, and the skin wound being sutured 

 with silk and treated as in the case of the umbilical variety. 

 A bandage is always advisable if the rent in the abdominal 

 wall has been at all a large one. 



With Inguinal Hernia there is sometimes a little trouble. 

 An attempt should always be made to reduce the hernia by 

 gentle pressure under a general anaesthetic when the parts are 

 thoroughly relaxed. Whether this can be effected or not, an 

 incision is made through the skin directly over the hernial sac, 

 care being taken not to penetrate this, in order to avoid making 

 an opening into the peritoneum. If the organs have not been 

 returned another attempt may now be successful, particularly if 

 the exterior of the sac be carefully separated from the surround- 

 ing skin by means of a scalpel handle or some blunt instrument. 

 The extremity of the sac is seized with a pair of pressure 

 forceps (Spencer Wells' or Pean's artery forceps answer 

 admirably), and the sac itself twisted slowly round until it 

 forms a kind of pedicle, around which a ligature of aseptic 

 silk or gut can be placed. The lower portion of the sac is 

 then cut off, and the external wound is 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 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 silkworm gut, a pressure pad of 

 aseptic wadding being applied or not according to discretion, 

 and the external wound sutured. 



At times it is found necessary to incise the inguinal ring 

 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 



