Hernia

Femoral Hernia Repair (Open) (McEvedy) (Emergency)

OPERATION: Femoral Hernia Repair (Open) — McEvedy Approach (Strangulated)
ANAESTHETIC: General anaesthesia
ANTIBIOTICS: Broad-spectrum IV antibiotics at induction
POSITION: Supine. Urinary catheter inserted pre-operatively.

INDICATION:
Strangulated [right / left] femoral hernia with [tender irreducible lump / features of bowel obstruction]. Emergency repair via McEvedy approach — chosen to allow access to assess bowel viability and perform resection if required.

PROCEDURE:
WHO Checklist performed. Abdomen and groin prepared.

ACCESS:
Oblique incision from 3 cm above the pubic tubercle running superolaterally for 7-8 cm, crossing the lateral border of the rectus. Skin flaps reflected. Lower rectus sheath incised 1-2 cm from and parallel to its lateral border. Lateral edge of sheath elevated; transversalis fascia incised from 2.5 cm above the pubic tubercle. Inferior epigastric vessels identified, ligated, and divided. Neck of hernia visible entering the femoral canal.

HERNIAL SAC:
Lower skin flap retracted; sac isolated and reduced by manipulation from above and below. Sac opened and contents assessed for viability. [Peritoneum opened above neck if bowel assessment or resection required.] Sac emptied, transfixed, ligated, and neck divided.