During surgical repair of hernia, the sac of a strangulated inguinal hernia should be opened at the:

In surgical repair of strangulated hernia, all the steps as in herniotomy operation is same till the sac is identified. Once the sac is identified a fundus first method is followed. In this method, fundus of sac is opened first or aspiration of the toxic fluid is done before handling the constriction. Doing so has the following advantages such as: Contamination of peritoneal cavity by toxic or infected fluid of the sac is avoided. Strangulated loops of bowel will not slip inside the peritoneal cavity without proper examination of the intestinal loop to rule out any gangrene. Strangulated hernia occur when blood supply to the contents of the sac is obstructed resulting in gangrene of the contents of the sac. Ref: Essentials of Abdominal Wall Hernias By V. K. Nigam, Nigam page 180