Search

Wantz writes that the purpose of this atlas is to teach hernia surgery the way it is taught in the operating room—by visual demonstrations and precise instructions. The visual demonstrations are enhanced by the clear illustrations by Caspar Henselmann, and the instructions are succinct and informative. I believe Wantz has admirably achieved his purpose. The atlas discusses the anatomy, etiology, and repair of abdominal wall hernias. Wantz includes only techniques that he regularly uses. When he speaks of the "preferred method," the reader should remember that this is the author's preferred method. An excellent bibliography is included at the end of each chapter. In the chapter on the anatomy, the author emphasizes that direct, indirect, and femoral hernias are not separate entities, but all begin as a weak area in the myopectineal orifice of Fruchaud, and can be eliminated either by repairing this orifice or substituting a prosthesis for the

THE TECHNIQUE of carotid endarterectomy is now quite standardized. Details vary with the particular case and the particular surgeon. But regardless of the technique used or the surgeon performing the procedure, occasional serious technical problems present themselves when the clamps are removed and flow is reinstituted in the endarterectomized vessel. The particular problem dealt with in this report is massive bleeding from a "blowout" in the wall of the endarterectomized vessel quite separate from the suture line. This can be due to an actual mechanical perforation of the wall during the endarterectomy. More frequently it is due to a disintegration of an unusually thin vessel wall. At best the remaining vessel is thin, and it is somewhat surprising that this complication is not seen more frequently. Once it is apparent, however, the surgeon's problem is to repair it without ruining the endarterectomy or narrowing the vessel. A simple closure of