Reply To: Questions concerning open surgery fro Direct inguinal hernia

[drtowfigh]

1) still have to dissect out the cord, as it lays on top of the direct hernia and prevents you from repairing it if not dissected out
2) for direct hernias it’s a weakness not a tear of the transversalis fascia
3) for direct hernias, the weakness
should be plicated prior to mesh placement. Most surgeons are unaware of this important step for optimal direct hernia repair.
4) mesh will be touching everything it’s laid on
5) stitched to the rectus sheath. Need 2-3 Sutures
6) if no looseness then it will be tightened leading to chronic pain or recurrence.
7) it’s a problem. I often wrap it with anti adhesive barrier
8) N/A as the cord should be dissected and all nerves must be identified