A 55-year-old man undergoes repair of a large left-sided groin hernia. At operation the surgeon finds the sigmoid colon descending into the scrotum, firmly fused to the posterior wall of the hernial sac. Which statement correctly explains the operative management of this sliding hernia?

• A The sac must be completely excised because it is a true peritoneal sac on all sides
• B The colon must be reduced after dividing its mesocolon to mobilise it fully
• C The viscus forms part of the sac wall, so the sac must not be excised and repair proceeds without opening it ✓
• D The sac is always opened and the bowel resected before reduction

Explanation

In a sliding hernia a retroperitoneal organ, classically sigmoid colon on the left or caecum on the right, protrudes with its own retroperitoneal covering so that the organ itself constitutes part of the posterior sac wall. Excising such a sac risks devascularising or perforating the bowel. The safe technique reduces the viscus and repairs the defect without formal sac excision. Dividing the mesocolon or resecting bowel is unnecessary and dangerous in uncomplicated cases.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

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Written and medically reviewed by the StethoPrep medical team.