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Show Mitiflm‘g GPERAIION FOR FEMORAL HERNIA: OPERATION ron FEMORAL HEBNIA. OPERATION FOR FEMORAL BEENIA. Having disentangled the tumour from the binding of the general fascia of the thigh, we proceed as in the bubonocele, THE first incision may pass obliquely from above, inward, passing over the tumour in its length,if it be oblong; reaching a little further than the base of the tumour in both exa tremities, and proportioned to the thickness of the integu= ments and size of the tumour. This done, the tumour has twice presented to me in a very puzzling form. I was operating in the hospital of Edinburgh, in the night; the tumour might be said to rise under the knife (since the more it is dissected the fuller it expands, and the more freely it rises from the depth of its situation), and in this case it presented with a knobby irregularity, and quite destitute of elasticity. My assistants conceived that I 213 lifting the lamina of membrane with the point of the knife, and pushing the directory under them; at least one com- plete membrane, besides the proper peritoneal sac, invests the tumour. Certainly Mr. Pott was incorrect in saying that the femoral hernia is less subject to strangulation than the inguinal. The hernia is often small and runs a rapid course; and as to his opinion, that it may be reduced without cutting the fe~ The moral ligament, I believe this is equally incorrect in the general run of cases. I have always found the stricture particularly tight in this kind of hernia. But in this stage of the operation, we have to recollect the manner in which the tendon of the muscle of the belly is bound down by these fasciae, which I have described; and we have to wish that the stricture may be here (as I believe it generally is) different from the idea formed of it by Mr. Hey. Because, if the stricture be on the outer margin of the ligament of the thigh, though it be cut freely, yet the guard condensed omentum gave it a firmness, and the sac was stud= against future descent is not weakened ; whereas if the stric- ded on the outer surface with the enlarged glands of the groin. ture be found on the inner margin, and this edge be required to be cut up, it must weaken the guard of the tendon, at a place where there is a perpetual effort made to protrude the had got entangled with a set of diseased glands; but dissec- ting towards the passage, from under the ligament, I felt confident that I was right, since I traced the neck of the tumour from under the ligament. It was an omental hernia chiefly, having within it a small portion of the intestine. On another occasion, in assisting Mr. Lynn in operating upon a lady, the tumour had a very irregular and knobby form. I should have supposed that the irregularity proceed: ed from the glands; but on pressing these knobs, they were elastic and full of fluid. They proved to be vesicles or 1va datids attached to the surface of the herniary sac. Vile are reduced then to form our diagnosis from the precise place of the tumour, and from the manner in which it rises, as from under the ligament. This may be felt when thf.' parts are not strangulated. When strangulation and inflammation have taken place, and the surrounding cellular mem brane is full, if the feeling is less distinct, the symptoms 05 obstruction are more marked. bowels. Having opened the sac, then, with the precautions used in the inguinal hernia, we are, with the finger within the sac, to feel for the cause of strangulation, and finding it in the outer margin, endeavour to raise the sac and ligament on the point 0 the finger, and with the point of the scalpel, to scratch upward from the finger, so as to cut across these firm, tendinous cords. Now finding that the finger can be introduced, we may feel a stricture within; but from the circumstance which I have already explained, this tightness, though considerable, may not be the cause of strangulation; and by gentle efl‘ert, ' mm M099?" ! |
