Position the patient supine on the operating table. Elevate the side to be operated on slightly if the patient is obese. Plan a transverse skin incision that begins at a point on the midaxillary line that is halfway between the costal margin and the anterosuperior iliac spine. Progress medially to the lateral border of the rectus muscle. Deepen the incision until the fascia of the external oblique muscle is encountered. Split this muscular and aponeurotic layer in the direction of its fibers to expose the underlying
internal oblique muscle. This split should run from the tip of the eleventh rib laterally to the edge of the rectus sheath medially. Widely undermine each muscle layer as you proceed. Split the fibers of the internal oblique muscle in a similar fashion. Identify the underlying transversus abdominis muscle. Split its fibers and open the transversalis fascia, sweeping away a variable amount of preperitoneal fat to expose the peritoneum.