brief discription of herni and femoral hernia

1. Femoral hernia
A lec to 1st year

2. KNOWLEDGE WITH OUT
APPLICATION IS USELESS

4. • They need feedback for their efforts
• They have passion to learn.
• They learn by experience..
• They are focused and internally motivated.
• They learn in a non-threatening environment.
• When there is an opportunity to practice and
apply what they have learned.

5. Hernia
Definition : A hernia is an abnormal protrusion of a
cavity’s contents , but takes with it all the linings of the
cavity.
Composition of a hernia:
A hernia consists of three parts
1. The sac
2. The coverings of the sac
3. The contents of the sac

6. Epigastric hernia

7. Paraumbilical hernia

8. Incision hernia

9. Umbilical hernia

11. • The sac:
The sac of the hernia is a diverticulum of
peritoneum consisting of mouth , neck, body and
fundus .

12. The neck is usually well defined but in some hernia ,
such as direct hernia ,there is no actual neck. The
diameter of neck is very important as narrow neck
leads to strangulation of hernial contents.
• The coverings:
The coverings are derived from layers of cavity
through which sac passes
• Contents:
The contents of the sac are structures of the cavity
from which hernia is formed.

13. Types of abdominal hernia

14. Femoral hernia

15. Defination:
Femoral hernia is Protrusion of extra peritoneal tissue,
peritoneum & sometimes abdominal
content through the femoral canal.
Incidence of femoral hernia is greater in females as
compared to males

16. Patient with right sided femoral hernia
Femoral
herina

18. Femoral
SHEATH . CANAL . RING

19. Femoral sheath

20. Anterior wall of Femoral sheath

21. Posterior wall of Femoral sheath

22. Femoral ring

23. Boundaries of Femoral ring
• Superoanteriorly: inguinal ligament
• Inferoposteriorly: iliopectineal ligament
• Medially : lacunar ligament
• Laterally : thin septum which
separates femoral canal & femoral
vein

24. Femoral canal
Medial most part of femoral sheath forms the femoral canal .
It is wide superiorly and narrow inferiorly.

25. How to differentiate between inguinal hernia and
femoral hernia
property Inguinal hernia Femoral hernia
sex More in males More in femals
site Above and medial to pubic
tuberlce
Below and latteral to pubic
tubercle
Cough
impulse
Positive except in obstructed hernia negative

26. RISK FACTORS
1. Female ( wide femoral canal)
2. Old ages
3. Low weight, elderly females

27. Clinical features
• Right side is more commonly affected
• Small swelling below the inguinal lig. very often
unnoticed
• Expansile impulse is often not present due to narrow
canal
• Swelling is below and lateral to pubic tubercle
• Strangulation 30-80%

28. Investigations
• Ultrasound along with all base lines ( CBC,
PT/APTT, RFTs,LFTs, S/E, Viral markers)
• ECG
• Chest X ray

29. TREATMENT
3 classical approach of open repair:
i. Low approach (Lockwood)
below the inguinal ligament
ii. Inguinal approach (Lotheissen)
through inguinal canal
iii. High approach (McEvedy)
mainly above the inguinal canal

30. Laparoscopic approach
• TEP and TAPP approach can be used
• Ideal for reducible femoral hernias, not in
emergency cases nor for irreducible hernia