During elective repair of a large left indirect inguinal hernia in a 60-year-old man, the surgeon finds that the sigmoid colon forms part of the posterior wall of the hernial sac. What is the correct operative principle?
- A Reduce the contents without opening or excising the sac, then proceed with mesh repair ✓
- B Open the sac widely and resect the involved colon segment
- C Excise the entire sac to prevent recurrence
- D Convert to a laparoscopic approach immediately
Correct answer: A. Reduce the contents without opening or excising the sac, then proceed with mesh repair
Explanation
This is a sliding hernia: the viscus, typically sigmoid colon on the left or caecum on the right, forms part of the wall of the sac itself. Opening or excising such a sac risks enterotomy and faecal contamination of the mesh. The correct technique is to reduce the contents intact, leave the visceral portion of the sac in situ, and complete a standard tension-free repair. Resection is reserved for actual strangulation.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.