■ HERIA OPERATIONS 217 



/ 

 tive area and inducing complete anesthesia, make 



an incision through the skin over the hernial sac, 

 pick the sac up with the forceps, and carefully 

 incise it without wounding its contents. Break down 

 any adhesions, and return contents to the abdomen. 

 Seize the extremity of the sac with a pair of artery 

 forceps and twist the sac until it forms a sort of 

 pedicle, and around this place an aseptic silk liga- 

 ture. Cut off the lower portion of the sac, suture 

 the external wound, dry, and seal with the iodized 

 collodion. 



At times it is found necessary to enlarge the in- 

 ternal ring before reduction is possible. This must 

 be done with great caution with the probe-pointed 

 bistoury or proper hernia knife, always remembering 

 that the external pudic vessels and nerves are situ- 

 ated toward the middle line and pass through the 

 ring. 



Scrotal Hernia 



Scrotal hernia manifests itself as a soft, fluctuat- 

 ing, painless, and usually reducible swelling in the 

 scrotum, the reduction being accompanied by a 

 gurgling sound. 



Technic. — Disinfect the scrotum and anesthetize. 

 Reduce the hernia, make an incision in the long axis 

 of the scrotum down to the tunica vaginalis testis, 

 and separate the latter from the surrounding tissues. 

 Pull the testicle down and ligate the cord as high 

 as possible above the ligature. Remove the testicle, 

 leave the scrotal wound open, and treat antiseptically. 



Perineal Hernia 



This occurs as a soft swelling at the side of the 

 anus. The herniated organs are usually omentum 

 or bowel and the bladder. 



In the latter case the condition is dangerous, as 

 the bladder is twisted on itself and retention of urine 



