Every surgeon has encountered difficulty in dissection of the indirect inguinal hernia sac. If the hernia is large, hypertrophy of the musculofascial tissues of the cord occurs and the sac so envelopes the cord structures that in freeing it by his usual method the surgeon may soon find himself in a maze of tissue planes. Other difficulties arise in being unable to locate a small patent process vaginalis of a communicating hydrocele, with the excessively fatty cord, or when there is a sliding component to the hernia.Surgical atlases and textbooks depict, and it is likely most surgeons use, a technique of total cord mobilization with opening and dissection of the sac from the cord structures. However, to turn things about and to dissect the cord structures from the sac simplifies the isolation of the hernial sac in all types of indirect hernia. The technique is described in this
MIROV AG. The Inner Cord—Systematic Approach to Inguinal Hernia. Arch Surg. 1964;89(6):1016–1020. doi:10.1001/archsurg.1964.01320060084016
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