Cooper’s Ligament Herniorrhapy (McVay)
Make a skin incision over the region of the external inguinal ring and continue laterally to a point about 2 cm medial to the anterior superior iliac spine. Open the external oblique aponeurosis with an incision along the line of its fibers from the external inguinal ring laterally for a distance of about 5–7 (see Fig. 76-2). Mobilize the spermatic cord. Excise the entire cremaster muscle from the area of the inguinal canal (see Fig. 76-3). Also remove any lipomas of the cord. Explore the cord carefully for the presence of the indirect sac. If a sac is present, dissect it from the cord. Open the sac, explore it, close the sac at its neck with a suture-ligature, amputate the sac, and permit the stump to retract into the abdominal cavity. Identify the external spermatic vessels at the point where they emerge from the transversalis fascia (see Fig. 76-7). Divide and ligate them at this point and remove about 4–5 cm of the vessels and ligate them again at the pubic tubercle (see Fig. 76-8).
KeywordsSpermatic Cord Inguinal Canal Transversalis Fascia Pubic Tubercle External Iliac Vein
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