Frequently, a small piece of synthetic mesh is used to close the defect in the inguinal ring. Less commonly, laparoscopic surgical techniques are used to repair inguinal hernias. Clip 1 Anterior superior iliac spin and pubic tubercle are identified. An incision is carried down through the skin subcutaneous tissue, Scarpa s fascia to the aponeurosis of the external oblique. The aponeurosis is then opened in the line of its fibers down to the external ring.
Care is taken to identify and preserve the ilioinguinal nerve.
Clip 3 After inspection, a direct hernia sac coming from transversalis fascia is easily identified. The sac is dissected off the cord using blunt dissection. The cord is identified and retracted. The hernia is reduced and using 3-0 Prolene, the transversalis fascia is reapproximated over the reduced hernia. The defect is repaired using 1-0 Prolene beginning at the pubic tubercle, the suture is placed and run proximally reapposing the conjoined tendon to the inguinal ligament and then back from the proximal end of the ligament, back toward the pubic tubercle.