Behind the knife

Management of inguino-scrotal hernias can be challenging. Traditionally, the hernia sac is completely reduced. Sac reduction can often result in excessive dissection and manipulation around the cord elements--resulting in trauma to structures, hematomas, and nerve injuries. To avoid these complications, some have advocate for abandonment of the distal sac, a maneuver commonly performed in open inguinal hernia surgery. This video reviews the technical considerations in performing a proactive primary sac abandonment and highlights recent work by Dr. Morrell and colleagues related to to this operative technique.