To ligate or not to ligate the hernial sac in adults?

OBJECTIVE: Prospective evaluation of the long term effect of leaving the hernial sac open without ligation on the recurrence rate of indirect inguinal hernia repair.

METHODS: During the period from July 1987 to July 1990, a total of 60 consecutive patients with 64 indirect inguinal hernia were entered into this prospective study. The indirect inguinal hernia was repaired using Maloney technique with excision of the hernial sac proximally as deep as possible without any attempt to ligate or transfix the sac. All patients were followed up at regular intervals.

RESULTS: During the 3-year period, a total of 64 indirect inguinal hernia in 60 consecutive patients were repaired. Their ages ranged between 15-85 years (mean of 50 years). The follow up ranged from 9-12 years (a mean of 10 years and 5 months). Four patients died of unrelated causes. There was no clinically documented case of recurrence in the remaining 56 patients.

CONCLUSION: This study, although not controlled, confirmed that non-ligation of the proximal sac during indirect hernia repair was not associated with an increase rate of recurrence.