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Indications

• Symptomatic herniae
• Irreducible herniae
• Patent processus vaginalis

Landmarks:

Inguinal Ligament (Gimbernaut):

• Formed from reflection of the aponeurosis of the external oblique muscle
• Runs from the Anterior Superial Iliac Spine (ASIS) to the pubic tubercle

Deep Ring: Midpoint of inguinal ligament

Superficial Ring: Above pubic tubercle

Ilioinguinal nerve

Position: Prone

Procedure

1. Incise skin 2cm above inguinal ligament from deep ring to superficial ring
2. Pass through superficial fascia/fat (Camper's)
3. Pass through deep fascia (Scarpa's)
4. Expose extern oblique apneurosis
5. Enter inguinal canal, identify and protect ilioinguinal nerve
6. Identify and protect the spermatic cord
7. Dissect hernia sac (anterior + superior to cord)
8. Open sac, inspect contents (may contain ovary in female), reduce hernia, close defect
   • If bowel present, check viability (wrap in warm saline-soaked abdominal pack)
   • If necrotic, must be resected
9. Reinforce wall with mesh
   • In children, repair is usually satisfactory, and don't need mes
   • Tension-free repair: Liechtenstein (lateralises cord)
   • Bassini repair
   • Shouldice repair
10. Ensure haemostasis, ensure testis in scrotum.