The attachments of the cremaster to the inguinal floor were divided using cautery. No direct hernia was evident.

The flaps of cremaster were clamped, excised and ligated, leaving the external spermatic vessels and genitofemoral nerve on the inguinal floor laterally.

The internal spermatic fascia covering the cord structures was opened. This usually thin filmy layer was thickened in this case from the chronicity of the hernia.