Skin Incision: 6-8 cm Oblique Incision Parallel and Just Superior to the Inguinal Ligament

Dissection

• Carry Incision Down Through the Subcutaneous Tissue and Scarpa’s Fascia
• Expose and Longitudinally Incise the External Oblique Aponeurosis to Enter the Inguinal Canal
  • Preserve the Ilioinguinal Nerve
• Mobilize and Isolate the Spermatic Cord and Encircle it with a Penrose Drain
• Dissect the Hernia Sac from the Spermatic Cord and Reduce It
• Consider High Ligation and Resection of the Sac vs Reduction Alone

Repair

• Incise the Posterior Wall (Transversalis Fascia) from the Internal Ring to the Pubic Tubercle to Expose the Preperitoneal Space and Facilitate Reduction of the Hernia Sac
  • *Many Modern Descriptions Omit This Step Although the Original Bassini Operation Included Opening of the Transversalis Fascia
• Approximate the Conjoined Tendon (Internal Oblique and Transversus Abdominis Aponeurosis) to the Inguinal Ligament
  • Classically Uses Interrupted Nonabsorbable Sutures
  • Begins Medially at the Pubic Tubercle and Proceeds Laterally
• Continue Until the Internal Ring is Recreated Around the Spermatic Cord without Constriction

May Create a “Relaxing Incision” of the Anterior Rectus Sheath if Under Perceived Tension

Closure

• Return the Spermatic Cord to the Inguinal Canal
• Close the External Oblique Aponeurosis Over the Spermatic Cord
  • Preserve the Ilioinguinal Nerve
• Close Scarpa’s Fascia and Skin