General Surgery

Femoral Hernia Repair

OPERATION: Femoral Hernia Repair (Open — Low Lockwood Approach)
ANAESTHETIC: General / spinal / local anaesthesia
POSITION: Supine

INDICATION:
Right / left femoral hernia. [Elective / emergency — incarcerated / strangulated].

PROCEDURE:
WHO Checklist performed. Transverse incision over the hernia in the upper thigh below the inguinal ligament, over the femoral canal. Dissection through subcutaneous fat. Cribriform fascia identified overlying the femoral canal. Hernia sac identified and defined.

Sac freed circumferentially. Sac opened and contents inspected — [empty / viable omentum / bowel]. [If strangulated: viability of contents assessed after releasing constriction — bowel viable / non-viable and resected]. Contents reduced or excised. Sac transfixed and ligated at neck as high as possible, allowing it to retract.

Femoral ring assessed. Repair with 2–3 interrupted non-absorbable sutures placed between inguinal ligament anteriorly and pectineal (Cooper's) ligament / pectineus fascia posteriorly, medial to femoral vein. Femoral vein protected with a finger throughout. Sutures all placed before tying, tied from medial to lateral until compression of femoral vein felt — remaining sutures removed. [Small mesh plug inserted to occlude ring].

Wound irrigated. Haemostasis confirmed.

CLOSURE:
Subcutaneous absorbable sutures. Skin clips / subcuticular suture.

FINDINGS:
[Right / left] femoral hernia. Sac contents: [empty / omentum / bowel — viable / non-viable]. [Bowel resection required / not required].

EBL: Minimal. COMPLICATIONS: None.

POST-OPERATIVE INSTRUCTIONS:
Regular analgesia. Same-day / next-day discharge. Light activities for 2 weeks.