\ 



OPERATION FOR INGUINAL HERNIA IN FEMALES 



373 



ANTISEPSIS. — The sutures used to close the orifice and 

 the incision must be of the sterilized variety, the instruments 

 should be boiled, the field shaved and cleansed, and the en- 

 virons moistened to prevent loosened hairs from falling into 

 the wound. 



RESTRAINT.— The patient is anjesthetized and then se- 

 cured in the dorsal recumbent posture, with the anterior part 

 of the body inclining, and the hind legs spread apart as far 

 as possible. 



TECHNIQUE. — An incision is made through the skin 

 along the long axis of the sac, without at first cutting the 

 peritoneum which lines it. The peritoneal sac is then dissected 

 free from the skin as far up as the level of the orifice. The 

 sac is then incised and examined as to the character of its 

 contents. Bloated intestines are collapsed by aspiration, the 

 gravid uterus is emptied of its foetuses by Cesarean section, 

 the bladder, if distended, is catheterized or its contents as- 



Fig. 184 — Inguinal Hernia in a Bitch. 



pirated with the trocar and canula. Attempt is then made to 

 reduce the contents by taxis, failing in which kelotomy may 

 be found necessary. The kelotomy,,when found necessary, is 

 performed at the anterior extremity of the orifice in order to 

 escape the large vessels that traverse in close proximity to 

 the posterior commissure. 



The sac is ligated close to the orifice with several wraps of 

 catgut and then cut off. The stump is pushed into the ab- 

 dominal cavity and the orifice sutured over it, with three or 

 more mattress sutures to close the orifice, and a continuous 

 suture to approximate the edges. The excessive skin pre- 

 viously constituting the sac is trimmed and then sutured with 

 silk from commissures to center, leaving an opening for drain- 

 age. 



AFTER-CARE.— Bandages are difficult to apply to this 

 region and if applied they are equally difficult to retain in po- 

 sition to do any useful service. It is, therefore, as well to 



