the fascial flap operation for inguinal hernia BY

EDRIC

Many

surveys of the results of

WILSON

operation

for

inguinal

hernia have been made, and

some have shown a very high recurrence rate. The survey to be described here shows the results of one type of operation only, that described by Sir Geoffrey Keynes in J927, and his description of its principle is worth quoting:?

The protrusion

occurs in the triangle bounded by the deep epigastric vessels on the outer edge of the conjoint tendon on the mesial side, and the pubic The transversalis fascia is bulged through this space, and even when the yide-mouthed sac has been ligatured and removed, it is impossible to suture the conJoint tendon to the inner part of the inguinal ligament in such a way as to form a strong e

,

outer one below.

side,

oor to

this part of the

inguinal canal; for there is an actual deficiency in the floor of permanently closed. A simple and satisfactory way ?, doing this is to use a flap derived from the internal oblique layer of the rectus tleath. The external oblique aponeurosis is lifted up, and can be separated from the internal layer without difficulty. A semi-circular flap is cut and turned over from above r?ugh 180 degrees so as to be beneath the spermatic cord. The cut edge is then SV\Ured to the inguinal ligament from the pubic spine outwards, almost to the internal d?minal ring. The flap then completely covers the site of the protrusion and forms a new strong floor to the inguinal canal. It is not under tension and will therefore not ne

inguinal

canal which must be

.

-dto retract afterwards". Much has been written, and many experiments made, to elucidate the cause of ^urrence, but this simple explanation covers the easily ascertainable facts. Many ethods, using absorbable or unabsorbable material, have been designed to cover the eak point, but their very number suggests that their success has been limited, and ssue irritation and sepsis have constantly given trouble. Walstead (1903) recounts his experience in the treatment of hernia. His article is Mainly concerned with the advantages and disadvantages of transplantation of the cord r reduction of its size, and attention is called to recurrence at the lower angle of the 5 ^ut he mentions that four years previously, when operating on a college friend, e used a flap of "aponeurosis covering the rectus muscle, as the internal oblique was attenuated and the rectus muscle did not seem to promise so much as its ^ fa sciaan-^ did". He then suggested that this method might have a wider application. The Peration is illustrated by one drawing, and from this it is clear that the aponeurosis of C oblique, forming the deep layer of the rectus sheath, had been used as the fl is drawing is reproduced by Jacobson (1915) with a brief description, and also an

The Fascial Flap Operation for Inguinal Hernia.

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