The operator must now choose one of two procedures. If the sac can be pulled upward through the femoral canal to the surface, it may be unnecessary to open the abdominal cavity until the sac itself is opened. This is facilitated by retracting the neck of the sac upward with forceps, while the operator applies counterpressure below Poupart's ligament through the hernial mass (Figure 4). If the sac cannot be reduced from beneath Poupart's ligament by this maneuver, it becomes necessary to dissect the subcutaneous tissue from the lower leaf of the external oblique until the hernial sac is exposed as it appears in the femoral canal beneath Poupart's ligament (Figure 5). Following this procedure, it is frequently possible to withdraw the hernial sac from the femoral canal, converting the femoral hernia to a diverticular type of direct hernia (Figure 6).