Femoral hernia

1.Position the patient supine.
2.The high approach (Nyhus) for emergency repair is as described under pelvic lymphadenectomy
3.For an elective repair a High approach can be undertaken as previously described. A low or Lockwood repair is performed as follows. Make a transverse incision parallel to the groin crease directly over the hernia.
4.Using sharp dissection with diathermy, dissect the margins of the hernial sac down to its neck.
5.Open the hernial sac and reduce the contents having examined them for viability.
6.If the contents of the hernia sac will not reduce, you may need to divide the lacunar ligament medially mindful of an accessory obturator artery. If strangulated bowel is encountered make a low midline incision and dissect down to the hernia sac in the extra-peritoneal plane as in a high approach. Incise the neck of the sac (constricting ring) medially, resect and anastomose bowel.
7.Repair the defect in the femoral canal by placing 2-3 2/0 prolene sutures between the inguinal ligament/iliopubic tract to Cooper’s ligament and tying them at the end, without compression of the femoral vein.
Lavage and close