Indirect hernia

The hernial sac can usually be found on the anterosuperior aspect of the cord. Subsequent management depends on the nature of hernial contents upon opening the sac:

• no contents:
  • an empty sac is carefully dissected out back to its origin on parietal peritoneum
  • it is twisted about its axis and then transfixed at the level of the deep ring with vicryl or chromic catgut
  • the sac is excised
    
    
• small bowel/omental contents:
  • if not infarcted, the small intestines are returned to the abdominal cavity
  • any adhesions are carefully divided
  • ischaemic bowel is resected and anastomosed
  • ischaemic omentum is excised
  • the sac is sutured and closed

Very large inguinoscrotal hernias present two potential problems:

• dissection from the cord and testis may devascularise these structures
• more extensive dissections predispose to postoperative haematoma Consequently, one approach is to:
• not dissect the sac
• reduce the contents of the sac to the internal ring
• transfix the sac at its neck ensuring that all contents are still reduced
• leave the distal wall of the sac in situ