From the Research
Relaxing the internal inguinal ring is recommended when reducing an incarcerated or strangulated inguinal hernia if the ring is constricting the intestine and preventing safe reduction, as supported by the most recent study 1. This procedure involves making a small incision in the superior aspect of the internal ring, typically in the 11 or 12 o'clock position, to enlarge the opening without damaging nearby structures like the ilioinguinal nerve or spermatic vessels. The incision should be made under direct visualization using a scalpel or scissors, cutting through the transversalis fascia and transversus abdominis aponeurosis that form the ring. Some key points to consider when performing this procedure include:
- The technique is essential when gentle traction fails to reduce the hernia contents, as forcing reduction without relaxing the ring risks intestinal injury.
- After making the relaxing incision, the surgeon should carefully examine the reduced bowel for viability, checking color, peristalsis, and pulsation in mesenteric vessels.
- The ring must be repaired after reduction to prevent recurrence, typically as part of the planned hernia repair.
- This approach balances the need to safely reduce the hernia contents while minimizing the risk of intestinal compromise, vascular injury, or damage to surrounding structures, as noted in 2 and 3. It's worth noting that while other studies, such as 4 and 5, provide additional context and techniques for hernia repair, the most recent and highest-quality study 1 provides the most relevant guidance for this specific procedure.