Modern inguinal hernia surgery has evolved over 120 years, with the classic tension-reinforced posterior wall repair pioneered by Bassini having dominated the field for nearly a century. With the development of biomaterials and the improvement of surgical skills, tension-free repair of hernias has gradually become a consensus in the surgical community since the 1980s. The other is the pre-peritoneal repair of the “pubococcygeal foramen”. Today, along with the process of specialization, hernia surgery is no longer considered a simple “minor surgery”, and to perform this surgery well, it is necessary to undergo serious study and professional training in order to achieve a clear anatomical level and accurate suturing, i.e. to comply with the standardization of hernia treatment. For tension-free hernia repair of the posterior wall of the “inguinal box”, these procedures include Lichtenstein’s simple flat repair and mesh plug repair such as Rutkow, Millikan, Trabucco and others. The so-called inguinal box, or inguinal canal. It has four walls: upper, lower, anterior, and posterior, and two ports: inner and outer. The inner port is the internal ring, also known as the deep ring; the outer port is the external ring, also known as the superficial ring. The upper wall is the bowed lower edge of the internal oblique and transversus abdominis muscles; the lower wall is the inguinal ligament and lumbrical ligament; the anterior wall is the tendon membrane of the external oblique muscle (the outer 1/3 part is still covered by the internal oblique muscle); the posterior wall is the transversus abdominis fascia (the inner 1/3 of which is still covered by the inguinal sickle). During the descent of the testis, the peritoneum, transversus abdominis fascia and all layers of muscles are driven to gradually move down the inguinal canal at the future inner ring of the inguinal canal, through which the male has a spermatic cord. When the spermatic cord enters the internal inguinal canal, it is surrounded by the internal fascia of the spermatic cord from the transversus abdominis fascia; the lowermost part of the internal oblique muscle sends out some thin scattered muscle fibers called levator muscle, which surrounds the spermatic cord; when passing through the external opening, it is surrounded by the external fascia of the spermatic cord from the superficial surface of the tendon membrane of the external oblique muscle. Incision and dissection An oblique incision is made parallel to 1 cm above the inguinal ligament, with the upper end 1 cm above the midpoint of the inguinal ligament and the lower end ending at the pubic symphysis. The skin and subcutaneous tissues (Camper’s fascia and Scarpa’s fascia) are incised. The extra-abdominal oblique tendon membrane and the external ring opening are exposed. Dissection of the external oblique tendon membrane The external oblique tendon membrane is dissected upward at the top of the external ring opening; the external oblique tendon membrane is lifted and fully free to the sides; the lateral border of the rectus abdominis sheath is reached inward and the inguinal ligament is revealed downward. The spermatic cord enters the scrotum through the external ring in a constant position, and after cutting through the external ring, the spermatic cord is wrapped by the levator muscle below it, and there is often the iliac inguinal nerve running through its surface. After cutting the levator muscle along the long axis with an electric knife, the spermatic cord is wrapped by the internal fascia of the spermatic cord underneath after the two skin clamps are drawn. The spermatic cord is released, a small pulling hook is inserted, and the levator muscle is pulled outward and upward (the pulling hook has a separating effect) to the mouth of the inner ring, which reveals the subabdominal vessels at the inner ring and also the genital branch of the genitofemoral nerve on the dorsal side of the spermatic cord. The hernial sac of hiatal hernia is located anteriorly above the spermatic cord and is wrapped by the internal fascia of the spermatic cord together with the spermatic cord. The hernia bursa of a hiatus hernia is basically unconnected to the spermatic cord and is located in the hiatus hernia triangle, above the spermatic cord. When the hernial sac is not seen in the spermatic cord after freeing the spermatic cord, it is often found within the rectus hernia triangle. At the same time, the spermatic cord should be carefully inspected after the discovery of the hernial sac to identify the presence of the hernia sac in order to avoid postoperative missed hernia (missed hernia). The hernia sac should be separated to the level of the internal ring (the gap between the hernia sac and the spermatic cord can be increased by hydrodynamic pressure to facilitate separation.) In smaller and medium-sized hiatal hernias, the free hernia sac can be easily reversed and retracted into the preperitoneal space without suture ligation; in huge direct hernias, the hernia sac is completely free and then reversed. A huge hernia sac slipping into the scrotum can be transected at the midpoint of the inguinal canal, sutured proximally and turned into the peritoneal cavity, and left in situ after hemostasis of the distal end. The medial aspect of the internal ring shows the subabdominal vessels located between the two layers of the transverse abdominal fascia. Multiple (3-4) small square pieces of gauze are inserted into the anterior peritoneal gap and freed in all directions. The gap is extended superiorly beyond the inferior arcuate border, medially to reach the outer edge of the rectus abdominis muscle, inferiorly and medially beyond the pubic tuberosity, and inferiorly and laterally beyond the Cooper ligament. The spermatic cord is separated from the peritoneum at the internal ring to “abdominal wallize” it. The hernial sac is treated as before and can be simply retracted, ligated or transected. The UHS patch or MK patch is placed, and the lower patch is pushed into the anterior peritoneal space and unfolded by pinching the upper patch between the fingers. The connecting post is threaded through the inner ring opening; the MK patch is inserted between the two layers of the patch with the index finger to guide the placement of the patch in the separated preperitoneal space, the traction band is cut, and the placement of the upper patch is the same as the placement of the mesh plug flat sheet. The connecting posts are appropriately retracted to fix the lower patch; the oval upper patch is spread flat over the subperitoneal gap of the extra-abdominal oblique muscle, posterior to the spermatic cord. and fix it appropriately. Finally, it is important to point out that the current process of standardization of hernia surgery techniques in China is far from adequate. There are still large differences in surgical techniques between urban and rural areas, between hospitals of the same level and between hospitals of different levels, which makes the surgical quality of inguinal hernia surgery heterogeneous and affects its efficacy. Therefore, more efforts are still needed to promote the standardization and standardization of hernia surgery operations. Only in this way can the overall level of treatment of hernia surgery in China be improved.