Femoral hernia surgery: Difference between revisions
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==Overview== | ==Overview== | ||
Surgery is the mainstay of treatment for femoral hernia. | [[Surgery]] is the mainstay of treatment for femoral hernia. Immediate surgical intervention is indicated in cases of [[Incarcerated hernia|incarceration]] or [[strangulation]]. The two popular surgical techniques are McVay repair and Lichenstein mesh repair. There is increased [[morbidity]] and [[mortality]] with surgical intervention in cases of [[strangulation]] or [[Incarcerated hernia|incarceration]] but it is still indicated. McVay repair is recommended in cases of intestinal incarceration as there is increased risk of [[infection]] following mesh repair in such cases. | ||
==Indications== | ==Indications== | ||
*The mainstay of treatment for femoral hernia is surgery. Immediate surgical intervention is indicated in cases of:<ref name="pmid7225757">{{cite journal |vauthors=Andrews NJ |title=Presentation and outcome of strangulated external hernia in a district general hospital |journal=Br J Surg |volume=68 |issue=5 |pages=329–32 |year=1981 |pmid=7225757 |doi= |url=}}</ref><ref name="pmid1958976">{{cite journal |vauthors=Gallegos NC, Dawson J, Jarvis M, Hobsley M |title=Risk of strangulation in groin hernias |journal=Br J Surg |volume=78 |issue=10 |pages=1171–3 |year=1991 |pmid=1958976 |doi= |url=}}</ref> | *The mainstay of treatment for femoral hernia is [[surgery]]. Immediate surgical intervention is indicated in cases of:<ref name="pmid7225757">{{cite journal |vauthors=Andrews NJ |title=Presentation and outcome of strangulated external hernia in a district general hospital |journal=Br J Surg |volume=68 |issue=5 |pages=329–32 |year=1981 |pmid=7225757 |doi= |url=}}</ref><ref name="pmid1958976">{{cite journal |vauthors=Gallegos NC, Dawson J, Jarvis M, Hobsley M |title=Risk of strangulation in groin hernias |journal=Br J Surg |volume=78 |issue=10 |pages=1171–3 |year=1991 |pmid=1958976 |doi= |url=}}</ref> | ||
**Strangulation | **[[Strangulation]] | ||
** | **[[Incarcerated hernia|Incarceration]] | ||
==Surgery== | ==Surgery== | ||
*Surgery is the mainstay of treatment for femoral hernia.<ref name="pmid1958976">{{cite journal |vauthors=Gallegos NC, Dawson J, Jarvis M, Hobsley M |title=Risk of strangulation in groin hernias |journal=Br J Surg |volume=78 |issue=10 |pages=1171–3 |year=1991 |pmid=1958976 |doi= |url=}}</ref> | *[[Surgery]] is the mainstay of treatment for femoral hernia.<ref name="pmid1958976">{{cite journal |vauthors=Gallegos NC, Dawson J, Jarvis M, Hobsley M |title=Risk of strangulation in groin hernias |journal=Br J Surg |volume=78 |issue=10 |pages=1171–3 |year=1991 |pmid=1958976 |doi= |url=}}</ref> | ||
*Surgery should not be delayed because of the high incidence of strangulation or incarceration.<ref name="pmid1958976">{{cite journal |vauthors=Gallegos NC, Dawson J, Jarvis M, Hobsley M |title=Risk of strangulation in groin hernias |journal=Br J Surg |volume=78 |issue=10 |pages=1171–3 |year=1991 |pmid=1958976 |doi= |url=}}</ref> | *[[Surgery]] should not be delayed because of the high [[incidence]] of [[strangulation]] or [[Incarcerated hernia|incarceration]].<ref name="pmid1958976">{{cite journal |vauthors=Gallegos NC, Dawson J, Jarvis M, Hobsley M |title=Risk of strangulation in groin hernias |journal=Br J Surg |volume=78 |issue=10 |pages=1171–3 |year=1991 |pmid=1958976 |doi= |url=}}</ref> | ||
*In case of incarceration or strangulation immediate surgical intervention is required regardless of age of the patient.<ref name="pmid7225757">{{cite journal |vauthors=Andrews NJ |title=Presentation and outcome of strangulated external hernia in a district general hospital |journal=Br J Surg |volume=68 |issue=5 |pages=329–32 |year=1981 |pmid=7225757 |doi= |url=}}</ref> | *In case of [[Incarcerated hernia|incarceration]] or [[strangulation]] immediate surgical intervention is required regardless of [[age]] of the patient.<ref name="pmid7225757">{{cite journal |vauthors=Andrews NJ |title=Presentation and outcome of strangulated external hernia in a district general hospital |journal=Br J Surg |volume=68 |issue=5 |pages=329–32 |year=1981 |pmid=7225757 |doi= |url=}}</ref> | ||
*Objectives of hernia surgery are:<ref name="pmid10954820">{{cite journal |vauthors=Hernandez-Richter T, Schardey HM, Rau HG, Schildberg FW, Meyer G |title=The femoral hernia: an ideal approach for the transabdominal preperitoneal technique (TAPP) |journal=Surg Endosc |volume=14 |issue=8 |pages=736–40 |year=2000 |pmid=10954820 |doi= |url=}}</ref><ref name="pmid12885618">{{cite journal |vauthors=Swarnkar K, Hopper N, Nelson M, Feroz A, Stephenson BM |title=Sutureless mesh-plug femoral hernioplasty |journal=Am. J. Surg. |volume=186 |issue=2 |pages=201–2 |year=2003 |pmid=12885618 |doi= |url=}}</ref><ref name="pmid14663407">{{cite journal |vauthors=Zandi G, Vasquez G, Buonanno A, Mazza P |title=[PHS Repair in femoral hernia surgery] |language=Italian |journal=Minerva Chir |volume=58 |issue=6 |pages=797–9 |year=2003 |pmid=14663407 |doi= |url=}}</ref> | *Objectives of [[hernia]] [[surgery]] are:<ref name="pmid10954820">{{cite journal |vauthors=Hernandez-Richter T, Schardey HM, Rau HG, Schildberg FW, Meyer G |title=The femoral hernia: an ideal approach for the transabdominal preperitoneal technique (TAPP) |journal=Surg Endosc |volume=14 |issue=8 |pages=736–40 |year=2000 |pmid=10954820 |doi= |url=}}</ref><ref name="pmid12885618">{{cite journal |vauthors=Swarnkar K, Hopper N, Nelson M, Feroz A, Stephenson BM |title=Sutureless mesh-plug femoral hernioplasty |journal=Am. J. Surg. |volume=186 |issue=2 |pages=201–2 |year=2003 |pmid=12885618 |doi= |url=}}</ref><ref name="pmid14663407">{{cite journal |vauthors=Zandi G, Vasquez G, Buonanno A, Mazza P |title=[PHS Repair in femoral hernia surgery] |language=Italian |journal=Minerva Chir |volume=58 |issue=6 |pages=797–9 |year=2003 |pmid=14663407 |doi= |url=}}</ref> | ||
**Reduction of the hernia | **Reduction of the [[hernia]] | ||
**Excision of the sac | **[[Excision]] of the sac | ||
**Closure of the femoral ring to prevent recurrence | **Closure of the [[femoral ring]] to [[Prevention (medical)|prevent]] recurrence | ||
*Surgical techniques used are either femoral or inguinal based approaches, used individually or in combination:<ref name="pmid10954820">{{cite journal |vauthors=Hernandez-Richter T, Schardey HM, Rau HG, Schildberg FW, Meyer G |title=The femoral hernia: an ideal approach for the transabdominal preperitoneal technique (TAPP) |journal=Surg Endosc |volume=14 |issue=8 |pages=736–40 |year=2000 |pmid=10954820 |doi= |url=}}</ref><ref name="pmid12885618">{{cite journal |vauthors=Swarnkar K, Hopper N, Nelson M, Feroz A, Stephenson BM |title=Sutureless mesh-plug femoral hernioplasty |journal=Am. J. Surg. |volume=186 |issue=2 |pages=201–2 |year=2003 |pmid=12885618 |doi= |url=}}</ref><ref name="pmid14663407">{{cite journal |vauthors=Zandi G, Vasquez G, Buonanno A, Mazza P |title=[PHS Repair in femoral hernia surgery] |language=Italian |journal=Minerva Chir |volume=58 |issue=6 |pages=797–9 |year=2003 |pmid=14663407 |doi= |url=}}</ref> | *Surgical techniques used are either [[femoral]] or [[inguinal]] based approaches, used individually or in combination:<ref name="pmid10954820">{{cite journal |vauthors=Hernandez-Richter T, Schardey HM, Rau HG, Schildberg FW, Meyer G |title=The femoral hernia: an ideal approach for the transabdominal preperitoneal technique (TAPP) |journal=Surg Endosc |volume=14 |issue=8 |pages=736–40 |year=2000 |pmid=10954820 |doi= |url=}}</ref><ref name="pmid12885618">{{cite journal |vauthors=Swarnkar K, Hopper N, Nelson M, Feroz A, Stephenson BM |title=Sutureless mesh-plug femoral hernioplasty |journal=Am. J. Surg. |volume=186 |issue=2 |pages=201–2 |year=2003 |pmid=12885618 |doi= |url=}}</ref><ref name="pmid14663407">{{cite journal |vauthors=Zandi G, Vasquez G, Buonanno A, Mazza P |title=[PHS Repair in femoral hernia surgery] |language=Italian |journal=Minerva Chir |volume=58 |issue=6 |pages=797–9 |year=2003 |pmid=14663407 |doi= |url=}}</ref><ref name="pmid12885618">{{cite journal |vauthors=Swarnkar K, Hopper N, Nelson M, Feroz A, Stephenson BM |title=Sutureless mesh-plug femoral hernioplasty |journal=Am. J. Surg. |volume=186 |issue=2 |pages=201–2 |year=2003 |pmid=12885618 |doi= |url=}}</ref><ref name="pmid14533910">{{cite journal |vauthors=Hachisuka T |title=Femoral hernia repair |journal=Surg. Clin. North Am. |volume=83 |issue=5 |pages=1189–205 |year=2003 |pmid=14533910 |doi=10.1016/S0039-6109(03)00120-8 |url=}}</ref> | ||
** | **McVay operation (basic hernioplasty operation) | ||
**Hernioplasties with prosthetic materials (polypropylene mesh, sutureless mesh-plug repair) | **Hernioplasties with [[prosthetic]] materials ([[polypropylene]] mesh, sutureless mesh-plug repair) | ||
**Laparoscopic approach | **[[Laparoscopic]] approach | ||
*McVay operation:<ref name="pmid14533910">{{cite journal |vauthors=Hachisuka T |title=Femoral hernia repair |journal=Surg. Clin. North Am. |volume=83 |issue=5 |pages=1189–205 |year=2003 |pmid=14533910 |doi=10.1016/S0039-6109(03)00120-8 |url=}}</ref> | |||
**[[Inguinal]] aproach | |||
**Insertion of the [[transversus abdominis muscle]] and [[transversalis fascia]] to the [[Cooper's ligaments|Cooper's ligament]] | |||
*Lichtenstein repair:<ref name="pmid14533910">{{cite journal |vauthors=Hachisuka T |title=Femoral hernia repair |journal=Surg. Clin. North Am. |volume=83 |issue=5 |pages=1189–205 |year=2003 |pmid=14533910 |doi=10.1016/S0039-6109(03)00120-8 |url=}}</ref> | |||
**PerFix [[mesh]] plug technique | |||
**Used for elective femoral hernia repair | |||
==Contraindications== | ==Contraindications== | ||
*When incarceration or strangulation is present surgical intervention does increase morbidity and mortality, but it still needs to be performed.<ref name="pmid7225757">{{cite journal |vauthors=Andrews NJ |title=Presentation and outcome of strangulated external hernia in a district general hospital |journal=Br J Surg |volume=68 |issue=5 |pages=329–32 |year=1981 |pmid=7225757 |doi= |url=}}</ref> | *When [[Incarcerated hernia|incarceration]] or [[strangulation]] is present surgical intervention does increase [[morbidity]] and [[mortality]], but it still needs to be performed.<ref name="pmid7225757">{{cite journal |vauthors=Andrews NJ |title=Presentation and outcome of strangulated external hernia in a district general hospital |journal=Br J Surg |volume=68 |issue=5 |pages=329–32 |year=1981 |pmid=7225757 |doi= |url=}}</ref> | ||
*In cases of [[Incarcerated hernia|incarceration]] or [[strangulation]] the mesh plug technique is avoided due to the risk of [[infection]], and the McVay repair is preferred.<ref name="pmid14533910">{{cite journal |vauthors=Hachisuka T |title=Femoral hernia repair |journal=Surg. Clin. North Am. |volume=83 |issue=5 |pages=1189–205 |year=2003 |pmid=14533910 |doi=10.1016/S0039-6109(03)00120-8 |url=}}</ref> | |||
==References== | ==References== | ||
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[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:Up-To-Date]] | [[Category:Up-To-Date]] | ||
[[Category:Emergency medicine]] | | ||
[[Category:Emergency medicine]] | |||
Latest revision as of 16:43, 20 August 2020
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Femoral hernia Microchapters |
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Treatment |
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Case Studies |
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Femoral hernia surgery On the Web |
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American Roentgen Ray Society Images of Femoral hernia surgery |
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Risk calculators and risk factors for Femoral hernia surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [2]
Overview
Surgery is the mainstay of treatment for femoral hernia. Immediate surgical intervention is indicated in cases of incarceration or strangulation. The two popular surgical techniques are McVay repair and Lichenstein mesh repair. There is increased morbidity and mortality with surgical intervention in cases of strangulation or incarceration but it is still indicated. McVay repair is recommended in cases of intestinal incarceration as there is increased risk of infection following mesh repair in such cases.
Indications
- The mainstay of treatment for femoral hernia is surgery. Immediate surgical intervention is indicated in cases of:[1][2]
Surgery
- Surgery is the mainstay of treatment for femoral hernia.[2]
- Surgery should not be delayed because of the high incidence of strangulation or incarceration.[2]
- In case of incarceration or strangulation immediate surgical intervention is required regardless of age of the patient.[1]
- Objectives of hernia surgery are:[3][4][5]
- Reduction of the hernia
- Excision of the sac
- Closure of the femoral ring to prevent recurrence
- Surgical techniques used are either femoral or inguinal based approaches, used individually or in combination:[3][4][5][4][6]
- McVay operation (basic hernioplasty operation)
- Hernioplasties with prosthetic materials (polypropylene mesh, sutureless mesh-plug repair)
- Laparoscopic approach
- McVay operation:[6]
- Inguinal aproach
- Insertion of the transversus abdominis muscle and transversalis fascia to the Cooper's ligament
- Lichtenstein repair:[6]
- PerFix mesh plug technique
- Used for elective femoral hernia repair
Contraindications
- When incarceration or strangulation is present surgical intervention does increase morbidity and mortality, but it still needs to be performed.[1]
- In cases of incarceration or strangulation the mesh plug technique is avoided due to the risk of infection, and the McVay repair is preferred.[6]
References
- ↑ 1.0 1.1 1.2 Andrews NJ (1981). "Presentation and outcome of strangulated external hernia in a district general hospital". Br J Surg. 68 (5): 329–32. PMID 7225757.
- ↑ 2.0 2.1 2.2 Gallegos NC, Dawson J, Jarvis M, Hobsley M (1991). "Risk of strangulation in groin hernias". Br J Surg. 78 (10): 1171–3. PMID 1958976.
- ↑ 3.0 3.1 Hernandez-Richter T, Schardey HM, Rau HG, Schildberg FW, Meyer G (2000). "The femoral hernia: an ideal approach for the transabdominal preperitoneal technique (TAPP)". Surg Endosc. 14 (8): 736–40. PMID 10954820.
- ↑ 4.0 4.1 4.2 Swarnkar K, Hopper N, Nelson M, Feroz A, Stephenson BM (2003). "Sutureless mesh-plug femoral hernioplasty". Am. J. Surg. 186 (2): 201–2. PMID 12885618.
- ↑ 5.0 5.1 Zandi G, Vasquez G, Buonanno A, Mazza P (2003). "[PHS Repair in femoral hernia surgery]". Minerva Chir (in Italian). 58 (6): 797–9. PMID 14663407.
- ↑ 6.0 6.1 6.2 6.3 Hachisuka T (2003). "Femoral hernia repair". Surg. Clin. North Am. 83 (5): 1189–205. doi:10.1016/S0039-6109(03)00120-8. PMID 14533910.