OPERATION FOR STRANGULATED HERNIA 365 



The greatest obstacle confronting the practitioner in de- 

 ciding upon operative intervention for strangulated hernia is 

 the fact that the operation can not very well be successfully 

 performed without sacrificing the testicle involved, and since 

 the loss of a testicle in a stud is a serious matter, the inclina- 

 tion to postpone is always quite as tenable as the decision to 

 operate immediately. Moreover, it is impossible under all 

 circumstances to lay down an absolute law as to when a colic 

 due to hernia actually requires an operation. What might 

 seem to be a threatening condition at the beginning may, after 

 a few hours of waiting, prove to be an entirely harmless colic 

 in no way associated with the hernia ; and on the other hand, 

 an at first apparently trivial colic may soon develop into a 

 plain case of intestinal strangulation. With these possibilities 

 in view, the plain duty is to give the suspect constant surveil- 

 lance and then operate just as soon as the diagnosis of stran- 

 gulation is established beyond doubt, and before the damage 

 to the incarcerated loop is too great. A too long delay in- 

 vites certain death, while a too early intervention needlessly 

 sacrifices the testicle. The surgeon's judgment protects 

 against these two evils by operating at the proper time. 



Above all things, the unwisdom of operating upon a hope- 

 lessly affected case, a dying subject, must be emphasized. 



TECHNIQUE.— The operation for the relief of strangu- 

 lated hernia does not differ materially from that performed 

 against non-complicated scrotal hernia (Vanlaw's opera- 

 tion). The patient is cast, anaesthetized, and rolled to the 

 dorsal posture. The tunica vaginalis is dissected out, the tes- 

 ticle removed and then the intestines are replaced into the 

 abdominal cavity. If any difficulty is encountered they are 

 punctured to reduce the volume and if still refractory kel- 

 otomy is performed. The extreme dark color of the incar- 

 cerated intestines is not always an indication of gangrene; on 

 the contrary, when the operation was timely, they are soon 

 restored to a normal condition after being released and re- 

 turned to their position within the abdomen. The color- 

 ation of intestines under the least provocation is a' property 

 belonging to them, and must not be misjudged in intestinal 

 surgery. 



In any event, especially in the large species of domestic 

 animal, the surgeon has done his full duty when he has re- 

 stored the strangulated intestines into the abdomen, because 

 the only other recourse (enterectomy and approximation) is 

 always futile. 



The intestines having been returned, the tunica vaginalis 



