Surgical management of large bilateral indirect sliding inguinal hernias

Abstract

<h2>Summary</h2> An unusual case of large bilateral indirect sliding inguinal hernias is presented. A simple method for disposition of the hernial sac is described. It includes excision of the cremaster muscle, complete separation of the sac and its contents from the spermatic cord, opening the sac in its superior portion, incision of the peritoneum medially and laterally to the sliding viscus, and approximation of the medial and lateral peritoneal leaves. The peritoneal ring is closed with a purse-string suture of heavy silk after the contained viscus has been replaced into the peritoneal cavity. High ligation of the sac after replacement of the viscus into the peritoneal cavity is a matter of importance if repair of the hernia is to be secure. The transversalis fascia is closed snugly about the cord at the internal ring. Identification of the transversalis fascia and firm closure of this structure give the repair its strength. Fundamentally, a sliding hernia is an acquired indirect inguinal hernia, and its repair can be simply accomplished. After the transversalis fascia has been closed almost any method that suits the surgeon's fancy may be used to complete closure of the floor of Hesselbach's triangle.