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When the external oblique fascia is sufficiently dissected away from the cord the hemostat on the upper edge of the external oblique fascia is released and the nerve is put of the outside of the external oblique fascia and the hemostat is reapplied.
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If located this is carefully dissected free from the cord with care taken to not directly grasp the nerve. Most surgeons then make a diligent search for the ilioinguinal nerve which usually lies on the anterior part of the cord. Blunt dissection is then used (usually a gauze sponge over the surgeons forefinger or thumb) to dissect the cord and internal oblique muscle away from the underside of the external oblique fascia. The free edges of the fascia are grasped with hemostats and used to retract the fascia up into the wound to expose the cord. The Metzenbaum scissors is then used to incise the external oblique fascia both cephalad and caudally.
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The closed tips of a Metzenbaum scissors are placed through this small incision and pushed under the external oblique fascia both caudally (toward the feet) and cephalad (toward the head) to dissect away the ilioinguinal nerve that may be on the anterior surface of the cord. A small incision is made in the center of the external oblique fascia along the lines of tissue. A self-retaining retractor (e.g., Weitlander retractor) is placed to allow good visualization of the external oblique fascia.
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The fascia of the external oblique is appreciated and dissected free of the surrounding tissue. Dissection is carried through the subcutaneous tissue and through Scarpa’s fascia with Bovie cautery.
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The incision is made through the skin with a No. The trend in hernia surgery is to make smaller incisions and most hernias can be repaired in non-obese patients through a 6-7 cm incision. If there is a palpable bulge the over the external ring the incision is carried down to this area. Incision Parallel to inguinal ligament – this is the most common incision and is made approximately two finger breadths above the imaginary line running from the anterior iliac spine to the tubercle of the pubic bone. They are caused by a weakness in the anterior abdominal wall muscles and by definition protrude medial to the inferior epigastric vessels. Direct inguinal hernia – these hernias are more common in older men.
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These hernias are extremely common and occur in 5% of men – they are the hernia that is most common in young men. Contents of indirect inguinal hernias can include fat, bowel, peritoneum, and bladder. By definition this hernia lies lateral to the inferior epigastric vessles. The tissue in this hernia projects through the internal inguinal ring that the spermatic cord and vessels traverse. Lichtenstein Repair (aka tension-free repair or plug-and-patch repair) Indications Indirect inguinal hernia – this type of hernia occurs because of the weakness of the tissue in and around the inguinal canal. They recommended the use of the plug for the repair of both femoral and recurrent inguinal. In fact, Lichtenstein and co-workers were the first to use the mesh ‘plug’ technique for hernia repair in 1974. The use of a mesh ‘plug’ to repair a primary inguinal hernia is said to offer further advantages over the standard Lichtenstein repair.