Femoral Hernia Repair

Procedure Snapshot

• Indication/urgency: Groin bulge below inguinal ligament; often incarcerated or strangulated → urgent repair.
• Expected duration: ___
• Special instruments: Small retractors, mesh or plug, inguinal set.

Step Workflow

1. Supine; transverse incision over femoral canal.
2. Identify inguinal ligament superiorly and femoral vein laterally.
3. Open lacunar ligament medially if needed; reduce sac.
4. Inspect viability of contents.
5. Close femoral ring (Cooper’s ligament sutures or mesh plug).
6. Close layers; avoid constricting femoral vein.

Key Pimp Questions

• Q: Which hernia most likely to incarcerate?
  A: Femoral hernia (narrow neck and rigid borders; PMID 25134072).
• Q: Borders of femoral canal?
  A: Inguinal ligament (anterior), Cooper’s ligament (posterior), femoral vein (lateral), lacunar ligament (medial).
• Q: What is “corona mortis”?
  A: Aberrant obturator vessel crossing Cooper’s ligament — bleeding risk.

Critical Anatomy

• Landmarks: Inguinal ligament, femoral vein, lacunar ligament.
• Danger zones: Corona mortis and femoral vein injury.

Informed Consent Highlights

• Risks: Recurrence ___ (PMID 28456672), nerve injury, seroma, mesh infection.

Post-op Considerations

• Early ambulation; avoid heavy lifting × 2 weeks.

References

• Chassin’s, Hernia section.
• Clinical Scenarios, Abdominal Wall chapter.
• Dahlstrand 2014 (PMID 25134072); Köckerling 2018 (PMID 28456672).