Sliding hernia repair

(A) The hernia sac is opened, exposing the intraperitoneal serosa-covered surface of the sliding sigmoid colon.

(B) The peritoneal portion of the sac is trimmed, leaving a cuff of peritoneum attached to the sigmoid colon, which can be everted for approximation across the extraperitoneal mesenteric area.

(C) The opposing leaves of the peritoneal cuff are sutured together from apex to internal ring.