1. A femoral hernia occurs when tissue protrudes through the femoral canal, a small opening in the abdominal wall. It is more common in elderly women and presents as a swelling in the groin area that increases with coughing. 2. Ventral hernias occur through abdominal wall openings except in the groin region. Common types are umbilical, epigastric, incisional, and Spigelian hernias. Umbilical hernias are present at birth while epigastric and incisional hernias develop later in life. 3. Incisional hernias form through postoperative scars and have risk factors like obesity, infection, and improper surgical

1. FEMORAL HERNIA

2. Diagram

3. BASIC ANATOMY OF FEMORAL CANAL
1.25 cm long and 1.25 cm wide.
Anteriorly by inguinal ligament.
Posteriorly by pelvic bone covered by the iliopectineal
ligament (Astley Cooper’s).
Medially by lacunar (gimbernat’s) ligament.
Laterally by femoral vein.

4. CLINICAL FEATURES
 Common in low weight, elderly women (F>M)
 More common on right side.
 Swelling in the groin below and lateral to the pubic
tubercle.
 Impulse on coughing, reducibility, dragging pain.
 Presents with features of intestinal obstruction— painful,
tender, irreducible swelling without any impulse. (50%)

5. DIFFERENTIAL DIAGNOSIS
1. Direct inguinal hernia
2. Lymph node
3. Saphena varix
4. Femoral artery aneurysm
5. Psoas abscess
6. Rupture of adductor longus with haematoma

6. SURGERY FOR FEMORAL HERNIA

7. APPROACHES
1. Low approach (LOCKWOOD)
2. Inguinal approach (LOTHEISSEN)
3. High approach (MCEVEDY)
4. Laparoscopic approach

8. VENTRAL HERNIA
Any protrusion through abdominal wall with the exception
of hernia through the inguinofemoral region is defined as
ventral hernia.

9. VENTRAL HERNIAS
1. Umbilical–paraumbilical
2. Epigastric
3. Incisional
4. Parastomal
5. Spigelian
6. Lumbar
7. Traumatic

10. UMBILICAL HERNIA

11. UMBILICAL HERNIAS
Umbilical hernia develops due to either absence of
umbilical fascia or incomplete closure of umbilical defect.
1. Congenital
2. Acquired
Congenital umbilical hernia is common in Africa or in
African origin people (8 times).

12. FEATURES
 Occurs in 10% of infants and higher incidence in
premature babies
 Appears within a few weeks of birth
 Asymptomatic
 Increases in size on crying
 Conical shape
 Both sexes are equally affected

13. TREATMENT
 Conservative under the age of 2 years.
 95% will resolve spontaneously.
 Beyond the age of 2 years surgery is indicated.

14. SURGERY

15. SURGERY
 Small curved incision is made immediately below the
umbilicus.
 Neck is opened and contents are returned to the
peritoneal cavity.
 Sac is closed and redundant sac excised.
 Defect in the linea alba is closed with interrupted sutures.

16. EPIGASTRIC HERNIA
 Midline defect in the linea alba between the xiphoid
process and the umbilicus.
 Occurs at the site where small blood vessels pierce the
linea alba.
 Usually less than 1 cm in maximum diameter and
commonly contain only extraperitoneal fat.

17. CLINICAL FEATURES
 Aged between 25 and 40years
 Soft midline swelling
 Cough impulse may or may not be felt
 Can be very painful, due to the partial strangulation
 Irreducible

18. TREATMENT
 Very small epigastric hernias: disappear spontaneously.
 Small to- moderate-sized surgery.

19. SURGERY
 Vertical or transverse incision
 Extraperitoneal fat
push back through the defect.
 Defect is closed
with non-absorbable sutures.

20. INCISIONAL HERNIA
A defect in the musculofascial layers of the abdominal wall
in the region of a postoperative scar.

21. INCIDENCE
 10–50% of laparotomy
 1–5% of laparoscopic port-site.

22. PREDISPOSING FACTORS
Patient factors
 Obesity
 Malnutrition
 Immunosuppression
 Steroid therapy
 Chronic cough
 Cancer

23. Wound factors
 Poor quality tissues
 Wound infection
 Vertical incision
 Layered closure of the abdomen
 Continuous closure
 Absorbable suture material has higher chances than non-
absorbable sutures

24. Surgical factors
 inappropriate suture material
 incorrect suture placement
 Emergency surgery
 Laparotomy for peritonitis

25. CLINICAL FEATURES
 Localised swelling
 Skin overlying large hernias; thin and atrophic
 Peristalsis may be seen
 Attacks of partial intestinal obstruction

26. TREATMENT
Principles of surgery
a. Repair should cover the whole length of the previous
incision.
b. Approximation of the musculofascial layers with
minimal tension
c. Placement of prosthetic mesh.

27. SURGERY
1. Open repair
2. Laparoscopic repair

28. SPIGELIAN HERNIA
• Hernial sac lies either deep to the internal oblique or
between external and internal oblique muscles.
• It is lateral ventral hernia through Spigelian fascia at any
point along its line.

29. ANATOMY OF SPIGELIAN HERNIA

30. FEATURES
 Presents as a soft, reducible mass lateral to the rectus
muscle and below the umbilicus
 Impulse on coughing
 Strangulation can occur
 Common in females after 50 years

31. TREATMENT
• Transverse incision herniotomy
• Closure of the defect layer by layer using nonabsorbable
interrupted sutures.