Femoral Hernia: A Review of the Clinical Anatomy and Surgical Treatment
- 1 Department of Surgery, Kameda Medical Center, Kamogawa, Japan
- 2 Department of Surgery, Kameda Medical Center, Kamogawa, Japan
Abstract
Purpose: Femoral hernia is a kind of ventral hernia that surgeons commonly encounter, second in frequency only to inguinal hernia. Femoral hernias often require emergency surgery because of incarceration or strangulation of the intestine. In addition, intestinal resection may need to be considered based on intestinal viability. Definitive preoperative diagnosis and strategic planning for surgery are thus important. The surgeon should consider the operation in the context of the clinical anatomy of the abdominal cavity. Therefore the essence of the clinical anatomy and treatment of femoral hernia is described. Methods: The medical records of 38 patients who underwent femoral hernia repair between March 2006 and November 2011 were retrospectively analyzed. Results: Femoral hernioplasty was performed with original mesh repair or Ruggi’s repair plus iliopubic tract repair (or Bassini’s repair). The mean patient age was 76.7 years, and a female predominance was apparent. Twenty-four patients underwent emergency surgery with a diagnosis of incarcerated femoral hernia. Nine patients showed intestinal strangulation and underwent resection of the small intestine. Four patients developed complications. One patient died due to aspiration pneumonia. No recurrences were encountered after 6 months to 6 years of follow-up. Conclusion: Femoral hernia is an important surgical condition with high rates of incarceration/strangulation and intestinal resection. Correct preoperative diagnosis of femoral hernia and a strict operative strategy are important. The original mesh repair is effective and easy to perform.
- U. Dahlstrand, S. Wollert, P. Nordin, G. Sandblom and U. Gunnarsson, “Emergency Femoral Hernia Repair. A Study Based on a National Register,” Annals of Surgery, Vol. 249, No. 4, 2009, pp. 672-676. http://dx.doi.org/10.1097/SLA.0b013e31819ed943
- C. E. Tobin, J. A. Benjamin and J. C. Wells, “Continuity of the Fascia Lining the Abdomen, Pelvis, and Spermatic Cord,” Surgery, Gynecology & Obstetrics, Vol. 83, No. 5, 1946, pp. 575-596.
- T. Sato, “Fundamental Plan of the Fascial Strata of the Body Wall,” Igakunoayumi, Vol. 114, No. 13, 1980, pp. C168-C175. (in Japanese)
- M. Mike and N. Kano, “Laparoscopic-Assisted Low Anterior Resection of the Rectum—A Review of the Fascial Composition in the Pelvic Space,” International Journal of Colorectal Disease, Vol. 26, No. 4, 2011, pp. 405-414. http://dx.doi.org/10.1007/s00384-010-1107-2
- T. H. Quinn, “Anatomy of the Groin: A View from the Anatomistm,” In: L. M. Nyhus and R. E. Condon, Eds., Hernia, 5th Edition, Lippincott Williams & Wilkins, Philadelphia, 2002, pp. 55-70.
- R. Bendavid, “The Transversalis Fascia: New Observations,” In: R. Bendavid, J. Abrahamson, M. E. Arregui, J. B. Flament and E. H. Phillips, Eds., Abdominal Wall Hernia, Springer, New York, 2000, pp. 97-100.
- M. S. Kavic, “Chronic Pelvic Pain in Women,” In: R. Bendavid, J. Abrahamson, M. Arregui, J. B. Flament and E. H. Phillips, Eds., Abdominal Wall Hernias, Springer-Verlag, New York, 2001, pp. 632-638. http://dx.doi.org/10.1007/978-1-4419-8574-3_94
- I. L. Lichtenstein, A. G. Shulman, P. K. Amid and M. M. Montllor, “The Tension-Free Hernioplasty,” The American Journal of Surgery, Vol. 157, No. 2, 1989, pp. 188-193. http://dx.doi.org/10.1016/0002-9610(89)90526-6
- P. K. Amid, A. G. Shulman and I. L. Lichtenstein, “Critical Scrutiny of the Open “Tension-Free” Hernioplasty,” The American Journal of Surgery, Vol. 165, No. 3, 1993, pp. 369-371. http://dx.doi.org/10.1016/S0002-9610(05)80847-5
- A. V. Moschcowitz, “Femoral Hernia: A New Operation for Radical Cure,” New York Medical Journal, Vol. 7, No. 10, 1907, p. 396.
- G. Ruggi, “Metado Operativo Meovo per la Cure Radicale Dell’Ernia Crurale,” Bull Sci Med Bologna, Vol. 7, No. 3, 1892, pp. 223-229.
- R. E. Condon, “Anterior Iliopubic Tract Repair,” In: L. M. Nyhus and R. E. Condon, Eds., Hernia, 3rd Edition, Lippincott, Philadelphia, 1978, pp. 195-211.