Colotomy

Abstract: improbable that the abdominal wall could be made strong enough to resist the pressure of the prolapsed intestines, therefore, in them obliteration of the hernial sac and suture of the abdominal wall should be followed by the wearing of a truss. In conclusion I ought, perlhaps, to refer to the operations of radical cure which may be performed after ketotomy. But so much has been written and said upon this subject that this may be done very briefly. First, however, it is not to be expected that anly of these procedures can be undertaken without danger unless perfect aseptic precautions are used and attained, and too much stress cannot be laid upon the importance of sterilizing the sponges, ligatures, instruments, and materials used in the operation. No operation for radical cure can be relied upon whihel does not achieve two tlings: first, absolute obliteration of the sac without leaving a depression at its opening into the peritoneum; and secondly, the repair of the abdominal wall. Macewen's operation fulfils these conditions, anid, as lhe and others have shown, can be practised with safety. However, I have found that as regards the treatment of the sac it has not always seemed wise to fold it into a pad, as Macewen recommends. In femoral hernihe the sae is sometimes in such a condition that it has been impractieable to convert it into a pad, and therefore I myself halve usually dealt with it as follows. Its neck is transfixed and then encircled with a long and moderately thick silk ligature, and securely tied. Next the ends of the thread are passed separately, about an inch apart, through the abdominal wall, well above Poupart's ligament, so that when they are pulled upon the neck of the sac ascends the crural canal and is fixed by tying the ligature. Afterwards Hey's ligament and the pubic portion of the fascia lata are brought together by suitable sutures, and the wound closed after having been irrigated with perchloride. The operation for the cure of inguinal herniia is more difficult to perform, and is now described in all the recent works on operative surgery. However, before undertaking its performance, it is highly desirable to take opportunities to practise its several steps. Macewen's operation, as regards its difficulties, seems comparable to staphyloraphy and requires a good knowledge of anatomy and considerable dexterity for its efficient execution.