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Indirect hernia

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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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

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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