- Accounts for 5% (5-10%)of Groin Hernias (96% are inguinal)
- More common in elderly women (F: M = 3:1).
Femoral canal - 1.25 cm long from the femoral ring above to the saphenous opening below.
- Associated with increased intra-abdominal pressure
- Hernia sac bulges into femoral canal, which is continuation of femoral sheath
- Femoral canal lies immediately medial to femoral vein
- Hernia is narrow in the canal
- No resistance at the saphenous opening - expands upwards towards abdomen, because the deep fascia of the abdomen is attached lower to the saphenous opening to the fascia lata.
- May form inverted retort shape - may traverse above Ing. lig.
- Predisposes to strangulation d.t. tortuous course, narrow canal, fixed rigid ring.
- Symptoms and Signs
- Groin Pain and tenderness often absent, strangulation occurs often without pain Q
- Hernia sac neck location palpable lateral and inferior to pubic tubercle
- Large femoral hernias may bulge over inguinal ligament
- Differential Diagnosis
- Inguinal Hernia, Inguinal Lymphadenopathy, Varix of Saphenous Vein (Thrill on palpation; Fills on standing and empties while supine).
- Infectious Bubo (Chancroid, Syphilis, Lymphogranuloma venereum)
- Varieties :
- Laugier's Femoral hernia - Occurs through a defect in the lacunar ligament (of Gimbernat). A small hernia in a very medial position. Almost always presents as strangulated.
- Narath's femoral hernia - Seen in Congenital dislocation of hip. Occurs due to lat displacement of the psoas. Q
- Cloquet's femoral hernia - Occurs behind the pectineus muscle. The hernia is behind the femoral vessels.
- Pre-vascular femoral hernia - Occurs in front of the inguinal ligament and the femoral vessels. Has a wide neck and less tendency to strangulate.
- Treatment : No role for conservative management e.g. truss
Operations : the hernia is reduced, & repair done by stitching the conjoint tendon to the Cooper's ligament.
- Low Approach ( LOCKWOOD)
Groin crease incision/ high risk of injury to abnormal obturator Artery/ not used in strangulation as intestine not well approached.
- High Approach ( McEVEDY)
Vertical incision over femoral canal extended over the ing. lig. up to the abdomen/ Good control over abnormal obturator Artery/ Useful in strangulated hernias/ higher risk of incisional hernia.
- Inguinal Approach ( LOTHEISSEN ) Q
Incision over inguinal canal/ Good control over abnormal A.
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