Femoral Hernia Repair

The femoral hernia accounted for 5% of the total abdominal hernia, which occurred in women over the middle age. There are many opportunities for incarceration in the femoral hernia, so it is advisable to repair it early. The diagnosis of femoral hernia is often difficult and even misdiagnosed. If the laparotomy is performed according to intestinal obstruction if it is not detected before surgery, it will cause difficulty during surgery. Therefore, patients with adult intestinal obstruction, especially female patients, should routinely check the thigh before surgery to avoid omission. The principle of the femoral hernia repair is basically the same as that of the inguinal hernia repair, mainly the high ligation of the hernia sac and the repair of the closed femoral canal. Intraoperative prevention should be done to avoid damage to adjacent tissues, especially the bladder, small intestine, and obturator arteries. The surgical approach for femoral hernia repair has two types, the transfemoral and the groin, both of which have advantages and disadvantages. Surgery through the thigh can directly enter the hernia sac, the operation is simple, but the exposure is poor, especially when the hernia sac is large, it is not easy to ligature high, the incarceration of the femoral hernia is not easy to release the incarceration, and it is not easy to perform intestinal resection when intestinal necrosis occurs. . Although the inguinal surgery is more indirect, it is better, and can be extended downward for longitudinal incision to facilitate the presentation of the hernia sac, which is easier to handle for larger hernia sac or incarcerated femoral hernia. Change the incision in the lower abdomen. Treatment of diseases: femoral hernia Indication The femoral hernia accounted for 5% of the total abdominal hernia, which occurred in women over the middle age. There are many opportunities for incarceration in the femoral hernia, so it is advisable to repair it early. The diagnosis of femoral hernia is often difficult and even misdiagnosed. If the laparotomy is performed according to intestinal obstruction if it is not detected before surgery, it will cause difficulty during surgery. Therefore, patients with adult intestinal obstruction, especially female patients, should routinely check the thigh before surgery to avoid omission. The principle of the femoral hernia repair is basically the same as that of the inguinal hernia repair, mainly the high ligation of the hernia sac and the repair of the closed femoral canal. Intraoperative prevention should be done to avoid damage to adjacent tissues, especially the bladder, small intestine, and obturator arteries. Preoperative preparation 1. To determine whether the diagnosis is oblique or straight, or whether the two coexist, whether it is slippery, whether there is incarceration or strangulation. 2. A detailed understanding of the severity of intestinal obstruction, dehydration, shock, etc., as well as serious diseases of the whole body, and actively take appropriate prevention and treatment measures. 3. Empty the bladder before surgery. Surgical procedure 1. The incision is 2 to 3 cm below the inguinal ligament, with the position of the femoral tube as the midpoint, and the oblique incision parallel to the ligament, about 6 cm long. In the case of incarcerated sputum, it is advisable to make a longitudinal incision in the femoral canal and extend it according to the intraoperative condition to expand the exposure range. 2. After revealing the sac and incision of the skin and subcutaneous tissue, the fat connective tissue (including the fascia, the septum and the extraperitoneal fat tissue, etc.) covering the surface of the sac is separated at the fossa fossa below the inguinal ligament. A sac. Use two small curved hemostats to clip the sac and cut the wall. Use a hemostat to clamp the cutting edge of the wall of the sac, and open and lift the incision of the wall to see the internal organs (small intestine or omentum, etc.) in the sac. Large saphenous veins can be seen under the neck of the sac, and care should be taken to avoid injury. 3. The high position ligation of the hernia sac is sent back to the abdominal cavity, and the neck of the sac is sutured with a high-grade silk thread, and then the excess sac is cut. 4. There are two ways to repair the femoral canal to repair the femoral canal: one is to sew the inguinal ligament on the pubic fascia, and the other is to sew the inguinal ligament on the pubic ligament. Three to four needles were sutured intermittently with a 4th wire, and after all the sutures were ligated, they were ligated one by one. Avoid saphenous veins and femoral veins when suturing to avoid injury. At the same time, pay attention to the suture not to be too close to the blood vessels, so as not to oppress the great saphenous vein into the femoral vein. 5. After suturing and carefully stopping bleeding, suture the fascia, subcutaneous tissue and skin around the lower mouth of the femoral canal.