What are the possible complications of removing the entire hernial sac in an open inguinal hernia repair?

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

In a complete indirect inguinal hernia, which descends into the scrotum, it is not necessary to remove the entire hernial sac; the sac may be transected in the distal inguinal canal, and the distal part of the sac in the scrotum can be left behind. Hemostasis, however, should be ensured at the cut edge of the distal part of the hernial sac to prevent bleeding and scrotal hematoma. In addition, to prevent the formation of a hydrocele, the distal sac should not be closed.

If it is not possible to return the contents of the hernial sac to the peritoneal cavity even after the sac has been opened, a sliding hernia is likely. Because the viscus is not inside the sac but makes up part of the wall of the sac, any attempt to excise the complete sac is likely to injure the viscus. Only that part of the sac that is distal to the sliding viscus should be excised; the sac is then closed, and the remaining sac, along with the viscus, is reduced into the extraperitoneal space.


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