IN 1938, Gertrude Herzfeld, Honorary Surgeon of the Royal Edinburgh Hospital for Sick Children, reviewed her experience with 1,000 cases of indirect inguinal herniorrhaphy in infants.1 In so doing, she detailed certain techniques and methods of management that are worthy of reemphasis today. Herzfeld pointed out that indirect inguinal hernias were simply congenital defects associated with a persistent patency of the processus vaginalis. She also appreciated the difficulties of conservative management with trusses and the inherent danger of incarceration facing a young infant. This realization led her to advocate performance of an elective herniorrhaphy at the time of first appearance of a hernia in all otherwise healthy infants.
Herzfeld's operative technique was a simple one, learned as a student of Sir Harold Stiles and his accomplished assistant, Sir John Fraser (written communication, 1966). Exposure through a small transverse incision was followed by opening the coverings of the cord at