Identifier: modernsurgerygen1914daco (find matches)
Title: Modern surgery, general and operative
Year: 1914 (1910s)
Authors: Da Costa, J. Chalmers (John Chalmers), 1863-1933
Subjects: Surgery Surgery, Operative
Publisher: Philadelphia, London, W. B. Saunders company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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etin 1898 (Progres Med., Sept. 21, 1901). Doyen and Winklemann do a simi-lar operation. Jaboulay, too, advocates splitting the sac and turning it insideout. He folds it around both the testicle and cord and stitches it so that the•smooth endotheUal surface of the tunic will be in contact with the raw scrotaltissue. It will adhere to the scrotal tissue (Keens Surgery, vol. iv). Alocal anesthetic is injected and an incision 2 inches in length is made. Thetesticle is lifted from the scrotiun. The serous and all the other coats exceptthe skin fall together behind and make a sheath for the cord. One catgutsuture will hold them behind the cord. A bed is made for the testicle beneaththe inner edge of the skin wound by tearing with the fingers. The testicle isrotated on its long axis and inserted into this cavity. The testicle rests againstthe scrotal septum, and in front of the gland is the cord covered by the tunic.The skin is sutured and the wound is dressed. E. Wylly Andrews devised the
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Tig. 942.—^Varieties of hydrocele: a, Congenital; b, infantile; c, funicular; d, encysted; e, vaginal. iottle operation (Keens Surgery, vol. iv). The unopened tunic (with thetesticle) is separated from the scrotum and dislocated through the scrotalwound. A small incision is made near the stunmit of the funnel-like prolon-gation of the sac upon the cord. The sac empties and then resembles a bottle orbag with a small opening at the top. The testicle is squeezed through theopening. When this is done the sac is inside out and the edges of the smallopening lie closely about the cord. The skin is closed without drainage. Insome cases after doing any one of the operations which turn the sac insideout a large tender mass forms, composed of swollen testicle and thickened sac.I have had this experience several times. In such a case it is necessary toexcise the thickened sac. Congenital hydrocele (Fig. 942, a) is hydrocele through an unclosedfimicular process into the tunica vaginalis. If the

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