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After induction of GA (General Anesthesia) and painting-draping, the affected side of the inguinal canal is opened by a small inguinal transverse crease incision, at its medial aspect, dividing external oblique aponeurosis (external sheath).
Reflected part of inguinal ligament is exposed, and the hernia sac along with cord structure is lifted on after reducing the sac contents, which may be loops of intestine, omentum or part of intraabdominal viscera like appendix, fundus of urinary blaster, tubes & ovary (in females). The cord structures along with vas defense are being separated from the sac. The sac is dissected free up-to the level of the internal inguinal ring, where it is ligated-transfixed, taking care not to include any abdominal contents. The distal part is kept open. If there is fluid within the distal sac, it is being evacuated protecting the testis, (as in case of Hydrocele). Proper hemostat is always considered to avoid postoperative hematoma formation. The testis is manually pulled within scrotum to avoid iatrogenic undescended testis. Orientation of vas deference with testicular vessels is preserved. The incision is closed in layers with repair of external oblique aponeurosis using absorbable sutures. Umbilical Hernia
MBBS, MS, MCh