After the incision has been made through the skin, a small curved mosquito hemostat is placed in the subcutaneous tissue on either side of the midportion of the incision for traction. Scarpa's fascia is exposed and divided. The underlying aponeurosis of the external oblique is cleared down to the external inguinal ring. The aponeurosis of the external oblique is then opened upward from the external inguinal ring. If there is no associated scrotal hydrocele, the incision through the external oblique aponeurosis may be placed just above rather than through the external ring. Superior and inferior flaps of the aponeurosis of the external oblique are developed with the scalpel handle, and a small right-angle retractor is placed under the superior flap to expose the inguinal canal. The cremasteric muscle fibers are separated by blunt dissection. The hernia sac is identified on the anteromedial aspect of the cord structures, lifted up, and gently separated in the midportion of the inguinal canal from the vas and the vessels. The cord structures themselves should not be mobilized from the inguinal canal. The sac is divided between two straight mosquito hemostats in the mid-portion of the inguinal canal, and the proximal portion is freed well above the level of the internal ring. The neck of the sac then is closed with a suture ligature of fine silk and the sac amputated. Ordinarily, it is not necessary to open the sac during this process. However, if omentum or a loop of intestine is within the sac, the sac is opened, and these structures are returned to the peritoneal cavity before the neck of the hernia sac is closed. The distal portion of the sac is freed below the level of the external ring and excised.