Skin and fascia are incised through a regular oblique inguinal incision to expose the external oblique aponeurosis. The thin, filmy fascial layer covering it is kept undisturbed as far as possible. The thinned out portion is usually seen at the top of the hernia swelling, extending and fanning out to the lower crux of the superficial ring. The external oblique is cut in line with the upper crux of the superficial ring, which leaves the thinned out portion in the lower leaf so a good strip can be taken from the upper leaf.
The external oblique, which is thinned out as a result of aging or long standing large hernias, can also be used for repair if it is able to hold the sutures. The cremasteric muscle is incised for the herniotomy and the spermatic cord together with the cremasteric muscle is separated from the inguinal floor. The sac is excised in all cases except in small…
