Fig. 620
Obliteration of the femoral opening by purse-string suture. (Coley.)
Recurrence after these operations occurs less and less frequently as operators gain in experience and technique is improved. At all events the procedure has now become standard and disappointments are relatively rare. It is useless to quote statistics of individuals, for they necessarily differ. In general, however, it is probable that from 90 to 96 per cent. of cases properly operated suffer no recurrence.
In the female inguinal hernia is treated in practically the same way, conditions being simplified by the absence of necessity for making any provision for the blood supply of the testicle or cord. The canal and rings may, therefore, in the female be absolutely closed.
Femoral hernia is radically treated on the same general principles, but with greater difficulty, as anatomical conditions are less favorable. A flap is raised below Poupart’s ligament, with its centre over the tumor, and the sac exposed and completely dissected, then opened, as in inguinal hernia. Its contents being reduced obliteration of the sac and its utilization, if possible, are in order. It is rarely difficult to separate it from its surroundings well up in the femoral canal. It may be twisted and its neck ligated, or it may be possible in some cases to either infold or reduce a sufficient portion of it to thus form a plug, which, being pushed upward, serves as a means of closing the femoral opening from above. Whatever use may be made of it it should be obliterated as a pouch, and its descent prevented by closure of the canal around it. This is difficult because of the proximity of the femoral vein and the somewhat unyielding character of the falciform and crural fasciæ. By some form of purse-string suture, or by a little dissection and sliding of aponeurotic flaps, it is usually possible to bring the surrounding structures snugly together. Even here I have been able to apply my principle enunciated above, and, by cutting away a strip of the sac, utilize it for the purpose of closing the femoral canal; but it is not often that a femoral pouch will be sufficiently large to afford tissues for this purpose. [Figs. 617], [618], [619] and [620] will save the necessity for further description.
Fig. 621
Fig. 622
