Lectures on Hernia and its Radical Cure

Abstract

Ancatomny of the Parts (f Crural Hernia. -Cause antl Formation of the Rupture.-Operation for its Radical Cure. -Sources of Failure and Danger. -Operation for the Radical Cure of Hernia after Kelotomy for Strangulation.-Umbilical Hernia.-Evolutionary Failures.-Antatomy.-Varieties.-Tavis.-Operation for Radical Cure.--Choice of Cases.-Review of the variouts MIethods of Attempting a Radical Citre of Hernia in Ancient and Modern Timnes.-Classification of Cases for Selection of Operation.-Conclusion. Anatomy of Crural Hernia.-In the hollow of the groin below the inner extremity of Poupart's ligament, and forming, with the deep and superficial abdominal rings, an inverted triang,le, of which it is the apex, lies the saphenous opening.Formed by the separation of the fascia lata into two layers, of which the outer or iliac part is advanced forwards by its attachment along the whole length of Poupart's ligament, and the inner or pubic portion, covering the sloping surface of the adductor and pectineus muscles, is attached to the pectineal line, and continued behind the sheath of the femoral vessels to be continuous with the ilio-psoas fascia, and connected with the capsule of the hip-joint; the saphenous opening presents an oval outline, looking forwards and a little dowvnwards and inwards.The outer border curves sharply inwards in a falciform manner, lies in front of the femoral vessels, and is attached to and blended with Gimlbernat's ligament by a process about half an inch wide, Hey's ligament, important to surgeons, because it crosses the upper part of the crural canal, and may be the seat of strangulation.Below, the falciform edge passes under the saphena vein, which curves over it to join the common femoral vein, receiving, as it does so, the veins which accompany the superficial branches of the common femoral artery, nlamely, the two external pubic, the epigastric, and the circumflex iliac.The first two pass inwards, the next upwards, and the last outwards.They supply the numerous lymphatic glands which lie in two groups in this situation, the upper directed obliquely along Poupart's ligament above and invested by Scarpa's fascia, and the lower lying parallel and internal to the saphena vein. Nearly all the afferent ducts of these glands pass in a body through the saphenous opening, the inner part of the femoral sheath, and the crural ring, to join the deep iliac and lumbar glands. The saphenous opening is covered in by a layer of fascia connected with its borders, called, from the numerous holes which transmit these lymphatics and some of the vessels, the cribriform fascia. This is blended, superficially, with the deep layer of superficial fascia of the thigh, and, deeply, with the inner part of the sheath of the femoral vessels.By detaching Hey's ligament from Poupart's, and turning down the fascia lata and cribriform fascia, the sheath of the femoral vessels is brouaht to view. It is arranged in three compartments ; the outer for the common femoral artery, the middle one for the vein, and the inner one, smaller ...

Edoardo Bassini and the Wound That Inspires

“…Wood, an English surgeon, attempted to reinforce the inguinal canal by isolating the sac, folding it back on itself, and using it as a tampon at the internal ring. The external ring was then closed and the aponeurosis of the external oblique muscle repaired [10]. Von Czerny, a first assistant to Billroth in Vienna, described a simpler technique that called for the high ligation of the hernia sac without opening the inguinal canal, followed by suture closure of the external ring [11].…”