Inguinal Hernia Repair Open by George Crawford, MD

Operative Steps

Generally, an incision is made over the inguinal canal, and it is carried down through the subcutaneous tissues.
Scarpa’s fascia is then identified and incised. If needed, hemostasis may be obtained using electrocautery.
The external oblique is identified. Typically, a small incision is made in the external oblique, and the Facia is separated and opened towards the external inguinal ring.
The external oblique is generally retracted laterally to expose the inguinal canal, as well as the cord structures.
The cord structures are dissected away from the pubic tubercle. Commonly, a Penrose drain is placed around the cord structures for retraction.
Dissection on the cord structures is typically performed mediately to laterally to identify the indirect hernia sac.

If present, the indirect hernia sac is dissected away from the cord structures, and then suture ligated.
The distal hernia sac is removed.
Cord lipomas are removed, using suture, ligation and electrocautery.
A mesh such as an ULTRAPRO™ Hernia System is placed in the internal inguinal ring and secured in place using interrupted technique with size 0 or 2-0 suture such as PROLENE™ Polypropylene.
Generally, attention is turned to the inguinal canal floor. A weakness of the floor can be repaired by securing the mesh of choice in place along the shelving edge of the inguinal ligament and the conjoined tendon.
If necessary, a suture may be used to re-create the internal inguinal ring.

A size 0 suture, such as Coated VICRYL™ Plus Antibacterial suture is generally used to re-approximate the external oblique fascia in a running fashion.
Size 3-0- suture, such as Coated VICRYL™Plus Antibacterial suture is used to re-approximate Scarpa’s Fascia.
The wounds are closed using synthetic absorbable suture, such as MONOCRYL™ Plus Antibacterial suture, and a topical skin adhesive such as DERMABOND™ Mini Topical Skin Adhesive, or any appropriate dressing.