The sac was opened on its anteromedial side to avoid injury to bowel. The sigmoid was densely adherent to the sac circumferentially. In the course of mobilization it was evident that part of the sac wall was made up of sigmoid (sliding hernia). The sac was freed at its junction with the sigmoid, leaving a defect in the posterior wall of the sac. The sigmoid was mobilized off cord structures deep into the internal ring.

The defect in the sac wall was closed with running 2-0 silk, starting at the deep inguinal ring.

The closure of the sac wall recreated a complete sac. The direct space was palpated through the open sac and found to be intact, but it was impinged upon by the dilated deep ring.