局麻下疝修补术02.pptVIP

There remained a thin layer of external spermatic fascia on the cord medial to the ring that needed to be cut to fully expose the cord. The same technique was used to open the external oblique laterally to the level of the deep inguinal ring. A moist sponge on a fingertip was used to dissect the canal contents off the medial and lateral flaps of external oblique aponeurosis. The inguinal canal contents were exposed.  The finger and sponge were rotated medially, rolling the cord off the medial and lateral crus of the external inguinal ring down to their attachment to the pubic tubercle (see inguinal anatomy). The lateral crus is seen here from the patients left side (head is to the right in this image only).  An additional 5 cc of local was injected beneath the cord at the pubic tubercle prior to mobilization. The spermatic cord was atraumatically mobilized from the pubic tubercle with small spreading movements of a blunt Pean clamp. A Penrose drain was passed under the spermatic cord.  The ilioinguinal nerve was elevated from the cremaster and sharply freed along its course. * * *