COMPREHENSIVE ATLAS OF SURGICAL TECHNIQUES
Skin incision. Two cm above and lateral from the pubic bone as horizontally as possible.
The fascia of the external oblique muscle is horizontally incised, the cord is isolated and taped.
Indirect hernia. The cord is opened and the peritoneal sack is separated from the testicular vessels.
The sack is dissected, opened to eventually drive its bowel content back into the peritoneum.
A. The empty sack is ligated at its origin.
B. The cremaster muscular bundles are re-approximated with a 3-0 Vicryl running suture.
Direct hernia. The spermatic cord is taped.
The direct hernia covered with the fascia transversalis sheath is dissected laterally. The epigastric vessels are visible.
A. The plastic mesh (minimesh technique) is prepared. It is beveled internally, opened longitudinally with a circumferential nick for the cord.
B. The mesh is inferiorly sutured from the pubis to the inguinal orifice. The lateral wings are pushed under the fascia and overlap.
Two upper sutures fix the mesh to the underlying muscle or the rectus abdominis muscle. The circular nick is also closed with a lateral resorbable suture (3-0 or 2-0 Prolene).