Femoral hernia surgery

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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.

The mainstay of treatment for femoral hernia is surgery. Immediate surgical intervention is indicated in cases of:^[1]^[2]
- Strangulation
- Incaceration

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]
- McVay operation (basic hernioplasty operation)
- Hernioplasties with prosthetic materials (polypropylene mesh, sutureless mesh-plug repair)
- Laparoscopic approach
McVay operation:
- Inguinal aproach
- Insertion of the transversus abdominis muscle and transversalis fascia to the cooper's ligament
Lichtenstein repair:
- PerFix mesh plug technique
- Used for elective femoral hernia repair

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.

↑ ^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.