direct hernia
Last reviewed 01/2018
A direct hernia is usually found as a wide bulge behind the transversalis fascia, or, occasionally, as a narrow-necked bulge through the transversalis fascia.
The former is dealt with simply by pushing it back behind the transversalis fascia. Then, the transversalis fascia is repaired. The sac does not need to be excised.
A narrow-necked direct hernia requires careful dissection of the sac. All of its contents are cleared. Then, catgut or vicryl is used to transfix its neck. This seals the defect. Care must be taken to ensure that the bladder is not filling the sac beforehand.
Even if a seemingly large direct hernia is repaired, it is prudent to examine the cord for an associated indirect hernia.