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Topographic Anatomy · Surgery for Abdominal Wall Hernias

Sliding hernias

Hernia labens

Sliding hernia is a specific pathology in which the sliding internal organ forms part of the hernia sac wall rather than simply lying within its lumen. This anatomical feature requires special care from the surgeon to avoid accidentally opening the organ lumen during surgery.

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Sac wallFormed by the wall of the sliding internal organ itself
Common organsUrinary bladder, cecum, sigmoid colon
OpeningPerformed widely, but at maximum distance from the organ
SuturingA purse-string suture is placed strictly from the inside of the hernia sac
3 min readFor medical studentsUpdated 09/24/2026
Material prepared by WhiteCoat Pro editorial team based on platform study guidesReviewed by medical editor: Aulov A. A., general practitioner · 09/24/2026

Anatomical specificity

The main distinguishing feature of Hernia labens lies in the structure of the hernia sac. Unlike classical hernias, where the sac consists entirely of the parietal peritoneum, here part of the hernia sac wall is formed by the displaced organ itself.

According to surgical practice, the wall is most frequently formed by:

  • Urinary bladder;
  • Cecum;
  • Sigmoid colon.

This is why the organ is not just ordinary «contents» of the hernia sac, its fundus, or its neck—it is physically integrated into the lining that bounds the hernia cavity.

Surgical access and opening

The surgical technique for sliding hernias aims at maximum preservation of the «sliding» component.

  1. Choice of incision site. The hernia sac must be opened widely, but this should be done at a distance from the internal organ itself. This prevents iatrogenic injury to the bowel or urinary bladder.
  2. Revision. After safely opening the lumen, the surgeon visualizes the hernia contents and gently reduces them back into the abdominal cavity.
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Handling and closure of the hernia sac

The most critical step is proper handling of the sac without damaging its specific wall. A strict algorithm applies here:

  • Suture placement. A purse-string suture is placed from the inside of the hernia sac. This is a key difference from many other hernioplasties.
  • Margin. The needle is passed at a distance of 2–3 cm from the edge of the organ forming the wall.
  • Excision of excess tissue. Excess tissues of the hernia sac are excised strictly distal to the purse-string suture (not higher than the inguinal ligament, not at the internal ring, and not proximal to the suture).

Reduction and hernioplasty

The final maneuver requires coordinated teamwork from the surgical team:

  1. When tightening the placed purse-string suture, the surgeon (or their assistant) uses their fingers to gently reduce the contents into the abdominal cavity.
  2. The threads are finally tied only after complete reduction of the organ.
  3. The surgery concludes with hernioplasty of the hernia ring. The choice of a specific hernioplasty method is performed using one of the standard techniques, selected individually depending on the localization of the defect.

Briefly: answers to topical questions

What specific methods of hernioplasty of the hernia ring are used at the final stage of surgery for sliding hernias?

At the final stage of surgery for sliding hernias, hernioplasty of the hernia ring is performed using one of the standard techniques depending on the localization of the hernia.

What is the anatomical mechanism of organ sliding during the formation of a sliding hernia?

The anatomical mechanism of sliding hernia formation is due to the fact that the wall of a hollow organ (e.g., urinary bladder or cecum) forms part of the hernia sac wall. This occurs due to the mesoperitoneal position of the organ, when it is not completely covered by the visceral peritoneum. When such an organ is distended, the hernia is able to «slip» back into the abdominal cavity.

Class and exam questions

Which structure forms a sliding hernia?

The internal organ (urinary bladder, cecum, or sigmoid colon) directly forms part of the hernia sac wall rather than simply being its contents.

How to properly place a purse-string suture in this pathology?

The purse-string suture is placed from the inside of the hernia sac, stepping back 2–3 cm from the edge of the sliding organ.

At what level is the excess hernia sac excised?

Excess tissue is excised strictly distal to the placed purse-string suture.

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What else to study on this topic

  • Relation of internal organs to the peritoneum (extra-, meso-, extraperitoneal)
  • Topography and surgical anatomy of the cecum
  • Syntopy of the urinary bladder and the risk of its injury
  • Standard methods of inguinal and femoral hernioplasty

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Other topics in the section «Surgery for Abdominal Wall Hernias»

Definition and classification of herniasInguinal herniasSurgeries for inguinal herniasSurgeries for congenital inguinal herniasFemoral herniasUmbilical herniasHernias of the linea albaHerniorrhaphy for strangulated hernias
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