Femoral hernia: It's protrusion of viscus or part of viscus through the femoral ring. Hernia has many serious complications if not managed properly.

1. Mohamed Kh. Elmesery
Tanta University
Femoral
Hernia

2. CONTENTS
• Anatomy
• Definition
• Incidence
• Causes
• Clinical features
• Diagnosis
• Treatment

3. FEMORAL
TRIANGLE

4. INTRODUCTION
BOUNDARIES
CONTENTS

5. BOUNDARIES
(Base) Inguinal ligament
(laterally) Sartorius
medially) Adductor longus
Apex
Right
Thigh

6. ROOF
Skin
Superficial fascia
--Superficial inguinal lymph nodes
--Femoral branch of genitofemoral nerve
--Branches of ilioinguinal nerve
--Branches of femoral vessels
--Great saphenous vein.
Deep fascia
--Saphenous opening and
--Cribriform
fascia.

7. Iliacus
Psoas major
Pectineus
Adductor longus
FLOOR
Lateral
Medial

8. --Fatty tissue
ROSENMULLER
GROUP OF
LYMPH
NODES(DEEP
INGUINAL)
Femoral
sheath

9. FEMORAL SHEATH

10. FEMORAL SHEATH
>Lateral/arterial compartment
>middle/venous compartment
>medial compartment/
FEMORAL CANAL
Walls :
Fascia TRANSVERSALIS(Ant)
-Fascia ILIACA (Post)

12. FEMORAL CANAL
-it’s the medial
compartment of femoral
sheath
-Conical, 1.5 cm long.
-Allows the Femoral Vein
to expand
-Contains lymph vessels,
A Lymph node
(CLOQUET ),fat
Femoral Ring

14. FEMORAL RING
Lymphatics
Areolar
tissue

15. Boundaries of
femoral ring
● Anterior: Inguinal ligament
● Posterior: Ligament of
Cooper ( pectineal
ligament).
● Medial: Lacunar
ligament (Gimbemat's
ligament)
● Lateral: Thin septum
which separates the
femoral canal from
femoral vein (silver
fascia).

16. FEMORAL HERNIA
-Through femoral ring into
Femoral canal
-Females > Males
-wider femoral ring
-wider pelvis
-small size of femoral vessels
-repeated pregnancies
Right side 2:1

18. .
• DOWNWARDS
• BACKWARDS
.
. • UPWARDS
. • DOWNWARDS
. • FORWARDS
. •UPWARDS
Direction of
hernial sac is
Typical.
Repair of
hernia
Femoral canal
Saphenous
opening
Superficial vessels

20. DDX
Femoral hernia
-Inferior
-Lateral
Inguinal hernia
-Superior
-Medial
To Pubic Tubercle

21. INGUINAL VS FEMORAL HERNIA
INGUINAL FEMORAL
Above and medial to the pubic
tubercle
Below and lateral to the pubic
tubercle
Above the crease
of the groin
Below the crease
of the groin
Can be reduced completely Cannot be reduced completely
Cough impulse
usually present
Many do not have cough
impulse

22. CLINICAL FEATURES
•Right side is more commonly affected
•swelling below the inguinal lig., 4cm below and lateral
to pubic tubercle
•Expansile impulse on cough but often not present 
due to narrowcanal
•Gaur sign : dilatation of superficial epigastric/ circumflex
iliac veins due to compression
•Reduction : ….
•Strangulation  30-80%

23. INVESTIGATION
•No specific investigations are required
•Ultrasound & CT scan
•Emergency patient , small bowel obstruction usually
occurs  plainX-ray

24. TREATMENT
3 classical approach :
i. Low approach (Lockwood)
below the inguinal ligament
ii. Inguinal ( high ) approach
(Lotheissen)
through inguinal canal
iii.
High approach (McEvedy)
mainly above the inguinal canal
*some cases can be managed
laparoscopically

25. High approach of Mc Evedy
Transinguinal approach of Lotheissen
Low approach of Lockwood

26. TREATMENT
1. Low approach (Lockwood)
•An incision is made over 1cm below and parallel
to the inguinal lig.
•The sac is opened and the contents are reduced
•Non-absorbable sutures are placed between
inguinal ligament & iliopectineal ligament

28. TREATMENT
2. Inguinal approach (Lotheissen)
•Transversalis fascia is opened from deep inguinal ring
to pubic tubercle.
•Hernia is reduced by combination of pulling from
above and pushing from below.
•Once reduced, neck of hernia is closed with sutures/
mesh plugs

29. TREATMENT
3. High Approach (McEvedy)
•Horizontal incision is made in lower abdominal centered at
lateral edge of rectus muscle.
•Ant. Rectus sheath is incised and rectus muscle displaced
medially.
•Hernia is reduced and sac is opened for careful inspection of
bowel.
•Femoral defect then is closed with sutures/ mesh

31. TREATMENT
4. Laparoscopic approach
•TEP andTAPP approach can be used
•A standard mesh is inserted
•Ideal for reducible femoral hernias, not in
emergency cases nor for irreducible hernia

32. DIFFERENTIAL DIAGNOSIS
• Direct inguinal hernia
• Lymph node
• Saphena varix
• Lipoma
• Femoral artery aneurysm
• Psoas abscess
• Rupture of adductor longus with haematoma

33. THANK YOU