A test for internal ring competency in open inguinal hernia repair.

A simple test for internal ring competency in open oblique inguinal hernia repair
After dissection of the sac, ligation at neck and cutting the excess part as usual, do not cut the thread, but suspend it on a small clamp and do a gentle traction; now, we notice a protrusion of the neck from the internal ring.
I recommend to plicate the transversalis fascia from medial to lateral to lateralize the cord and to narrow the internal ring just to admit the tip of an artery forceps as usual , I prefer on narrowing the ring to use simple stitches ,If the spermatic veins become congested ; the repair is too toted and one or more stitches must be removed.
Now, do a gentle traction on the neck by traction on the small clamp, if neck doesn’t protrude from the internal ring, the repair is perfect.
After fixing the mesh as usual I recommend to put one or two stitches to fix the mesh to the internal ring just medial to the cord .I think these stitches reduce recurrence even in non- tension repair to prevent protrusion of recurrence from the ring going under the mesh and cause post- operative chronic pain.
This traction test can also be used in direct hernia by traction on the doom of the sac.

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