Treatment of a sliding inguinal hernia is by repair. However, a sliding hernia may only be recognised at the time of operation. As with other inguinal hernias, the sac lies anteriorly, but its posterior wall is formed to a greater or lesser degree by the local viscus e.g. colon.
The cord should be dissected free from the sac. Then reduce the hernia by a series of inverting sutures - Bevan technique - and repair using one of the standard techniques.
For very large sliding hernias, it may be necessary to enter the peritoneal cavity through a back technique - La Roque - in order to reduce it. The bowel should be pulled back into the abdomen and fixed to the posterior abdominal wall, and the hernia repaired in the usual fashion.
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