Inguinal Hernia: Standard Procedure

Abstract

Inguinal hernia repair is usually performed after 3 months of age. The principle of repair is high ligation of the hernia sac or the patent processus vaginalis (simple high ligation). Open inguinal hernia repair by simple high ligation of the sac is called “Potts’ procedure,” although the principle had already been documented in the early nineteenth century. In Potts’ operation, a skin crease incision, approximately 2–2.5 cm in length, is made just above the internal inguinal ring. After the external oblique fascia is incised and the inguinal canal is exposed, the cremaster muscles (the internal oblique muscle in female patients) are bluntly spread apart, and the spermatic cord structure (the round ligament in female patients) and the hernia sac are identified. Then, in male patients, the vas and the testicular vessels are freed from the sac which is then transected. The presence of the round ligament is confirmed in female patients. The proximal part of the sac is freed as high as possible at the level of the internal inguinal ring, and it is doubly ligated by transfixation with unabsorbable sutures. When sliding hernia is present, the involved viscus is reduced to the abdomen, and the sac is doubly ligated distally to the viscus.

The selective sac extraction method (SSEM) is a hernia repair in which only the hernia sac is selectively extracted and doubly ligated through a small skin incision. Although finer skills are required, SSEM is a cosmetically excellent method with high patient satisfaction.

Postoperative complications include hemorrhage, wound infection, recurrence, male testicular dislocation, and testicular atrophy.

The figures in this chapter are reprinted with permission from Standard Pediatric Operative Surgery (in Japanese), Medical View Co., Ltd., 2013, with the exception of occasional newly added figures that may appear.