Fig. 4

Operative findings. a Small bowel dilatation and a loop of small intestine remained trapped in the hernia with a thickened peritoneum at the neck of the sac in the left inguinal. b The hernia sac(black arrow) was not associated with the processus vaginalis(black arrowhead), which had been closed by a previous open procedure. c The hernia neck was encircled without skipping. d The hernia neck received high ligation