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Femoral Hernia Repair with Modified Patch after Previous Inguinal Herniorrhaphy

Learn about a modified patch repair method for femoral hernias that occur after previous inguinal hernia repair. This less invasive approach is feasible with local anesthesia and provides less foreign body sensation.

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Femoral Hernia Repair with Modified Patch after Previous Inguinal Herniorrhaphy

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  1. Femoral Hernia after Previous Inguinal Herniorrhaphy Introduction af a Modified Patch Repair with Local Anesthesia Hakan KULACOGLU Celil UGURLU Zafer ERGUL Ipek OZYAYLALI Gaye SEKER • Dışkapı Yıldırım Beyazıt Teaching and Research Hospital, Department of Surgery, Ankara, Turkey. • Ankara Hernia Center, Ankara, Turkey

  2. %0.2 %0.2

  3. Femoral Hernia Repairwith Modified Patch Repair after Previous Inguinal Herniorrhaphy • Femoral hernia rare • FH after inguinal hernia repair still rare • Modified repair for a small subset of a specific problem

  4. WhyFemoral Hernia after Inguinal Herniorrhaphy ↑upward tension on the inguinal ligament can open femoral canal wide [Abrahamson] ↓inguinal hernia repair per se does not provide a disposition for femoral hernia itself [Kehlet] • probably an overlooked hernia

  5. Femoral Hernia Repairafter Previous Inguinal Herniorrhaphy • 4-year period • Totally 51 femoral hernias • 10 previous inguinal hernia repairs in 9 pts • 5 Lichtenstein, 5 Bassini (one bilateral) • 8 men (9), 1 woman Mikkelsen, Bay-Nielsen, Kehlet. Br J Surg 2002.

  6. Repair methods for 51 femoral hernias

  7. Shouldice Clinic Approach for Femoral Hernia Repair J AmColl Surg 2008;207:360–367

  8. Hernia sac Externus oblique aponeurosis (not opened) Femoral vein Pubic corner * Pectineus muscle

  9. Externus aponeurosis Inguinal ligament Hernia sac Pubic corner Lacunar ligament Femoral vein&artery Pectineus muscle

  10. Hernia sac Externus oblique aponeurosis (not opened) Femoral vein Pubic corner * Pectineus muscle

  11. Externus aponeurosis Inguinal ligament Hernia sac Pubic corner Lacunar ligament Femoral vein&artery Pectineus muscle

  12. Iliopectineal ligament Inguinal ligament Externus aponeurosis E Pubic corner F G Preperitoneal space A D C B Lacunar ligament Femoral vein&artery Cooper ligament Pectineus muscle

  13. SP E F G A IP B C D

  14. Iliopectineal ligament Inguinal ligament Externus aponeurosis E Pubic corner F G Preperitoneal space A D C B Lacunar ligament Femoral vein&artery Cooper ligament Pectineus muscle

  15. Externus oblique aponeurosis (not opened) Pubic corner * Prosthetic patch Femoral vein

  16. Repair methods for 51 femoral hernias

  17. Femoral Hernia Repairwith Modified Patch Repair after Previous Inguinal Herniorrhaphy • Does not abolish previous inguinal repair • Less invasive (than inguinal approach) • Less foreign body sensation (than a plug) • Feasible with local anesthesia (unlike laparoscopy)

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