The external oblique is carefully cleaned of all fat by sharp dissection throughout the length of the wound, and the external ring is visualized (Figure 2). After the margins of the wound have been covered with gauze moistened in isotonic saline, a small incision is made in the direction of the fibers of the external oblique, which extend into the medial side of the external inguinal ring (Figure 2). The edges of the external oblique are held away from the internal oblique muscle to avoid injury to the underlying nerves as the incision is continued through the medial side of the external ring (Figure 3). The nerves are most commonly injured at the external ring. The lower side of the external oblique is freed by blunt dissection down to include Poupart's ligament. The upper margin is similarly freed for some distance. As the ilioinguinal nerve is dissected free from the adjacent structures, a bleeding point is commonly encountered as it passes over the internal oblique (Figure 4). This bleeding vessel, if encountered, must be tied carefully; otherwise a hematoma may develop in the wound. When the ilioinguinal nerve has been carefully dissected free, it is pulled to one side over a hemostat placed at the edge of the incision (Figure 5). The cremasteric fibers are grasped with toothed forceps and divided in order to approach the sac (Figure 6). The sac itself is seen as a definite white membrane that lies in front and toward the inner side of the cord; it is usually easily differentiated from surrounding tissues. If the hernia is small, the sac lies high in the canal. The vas deferens can be recognized by palpation because it is firmer than the other structures of the cord. The wall of the sac is lifted up gently and opened with care to avoid possible injury to its contents (Figure 7). While the margins of the opened sac are grasped with hemostats, the contents are replaced within the peritoneal cavity. With the index finger of the left hand introduced into the sac to give counter-resistance, the surgeon frees the sac with the right hand by either blunt or sharp dissection (Figure 8). If the dissection is kept close to the sac, an avascular cleavage plane will be found. Sharp dissection is advisable to separate the vas deferens and adjacent vessels from the sac (Figure 9). If this is done carefully, fewer bleeding points will be encountered than if an effort is made to sweep these structures away from the sac by means of blunt dissection with gauze. The dissection is then continued until the properitoneal fat is displaced and the peritoneum beyond the narrow neck of the sac is visualized.