Femoral hernia

FEMORAL HERNIA

Jini P Abraham

Herniation of the intra-abdominal contents through the femoral canalLess common than inguinal herniaMore common in females; multipara20% - bilateral; more common on right sideEasily missed on examination

Surgical anatomyFemoral canal – Extends from femoral ring above and saphenous opening belowContents –

FatLymphaticsLymph node of

Cloquet

Boundaries –Anteriorly – Inguinal ligamentPosteriorly – Iliopectineal ligament of Cooper, pubic bone and fascia covering the pectineus muscleMedially – Lacunar ligament (Gimbernat’s)Laterally – Thin septum separating from the femoral vein

Wide femoral canalIncreased abdominal pressure due to multiple pregnancies

Etiology

Hernial sac descends down upto saphenous opening through the femoral canalRetort shapedMore prone to obstruction and strangulation

Pathology

Swelling in the groin (below and lateral to the pubic tubercle)Impulse on coughing, reducibility and dragging painObstruction or strangulation –

Painful, tender and inflamedIrreducibleNo cough impulseVomiting

Clinical Features

Dilatation of superficial epigastric/circumflex iliac veins – Gaur sign

Direct inguinal herniaEnlarged Cloquet lymph nodeSaphena varixFemoral artery aneurysmPsoas abscessHaematoma

Differential Diagnosis

Careful examinationUltrasonographyCT scanPlain X – ray -> small bowel obstruction

Investigations

Lockwood Low operation –Transverse incision made over the herniaSac opened and contents reducedSutures placed between inguinal ligament above and fascia overlying the bone belowNo risk of bowel resection

Treatment

Inguinal approach (Lotheissens’s) –Inguinal canal approachTransversalis fascia is opened and hernia is reducedNeck of hernia is closed with sutures or mesh

High approach (McEvedy) –Risk of bowel strangulationIncision made over femoral canal extending vertically above the inguinal ligamentHernia reducedSac exposed for careful inspection of the bowelFemoral defect closed with sutures or mesh

AK Henry’s approach –Repair of bilateral femoral hernia through lower abdominal incision

Laparoscopic approach –TEP and TAPP approaches used for femoral hernia and a standard mesh inserted.Ideal for reducible hernia

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