What precautions should be taken during an open inguinal hernia repair to prevent post surgery complications?

Updated: Jan 17, 2018
  • Author: Vinay Kumar Kapoor, MBBS, MS, FRCS, FAMS; Chief Editor: Kurt E Roberts, MD  more...
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Answer

Toward the deep inguinal ring, the hernia sac becomes thin and fragile and adheres more closely to the spermatic cord. Caution should be exercised in dissecting the hernia sac to avoid injury to the cord structures and splitting of the neck of the sac. In adults, the rate of vas deferens injury is estimated at 0.3%. To protect against such injury, the surgeon must always remain aware of the posterior location of the vas deferens when dissecting the hernia sac.

If reduction of the hernial sac proves difficult at operation, a sliding hernia should be suspected. The cecum (on the right side), the sigmoid colon (on the left side), and the urinary bladder (on either side) form the wall of the sac of a sliding hernia; they are not the contents of the hernial sac and are not inside the sac. In a sliding hernia, it is difficult to separate the hernial sac from the structures that form its wall; thus, the hernial sac should be reduced en masse along with these structures, without any attempt to separate them from the hernial sac.


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