1. Laugier’s femoral hernia Narath’s femoral hernia Cloquet’s hernia Hydrocele of the femoral hernia Hydrocele of the femoral hernia Hydrocele of the femoral hernia Hydrocele of the femoral hernia Laugier’s femoral hernia Laugier’s femoral hernia Laugier’s femoral hernia Laugier’s femoral hernia Laugier’s femoral hernia Laugier’s femoral hernia Laugier’s femoral hernia Laugier’s femoral hernia Laugier’s femoral hernia Laugier’s femoral hernia Hydrocele of the femoral hernia Hydrocele of the femoral hernia Hydrocele of the femoral hernia Cloquet’s hernia Cloquet’s hernia Cloquet’s hernia Cloquet’s hernia Cloquet’s hernia Cloquet’s hernia Cloquet’s hernia Cloquet’s hernia Cloquet’s hernia Cloquet’s hernia Cloquet’s hernia Cloquet’s hernia Laugier’s femoral hernia Hydrocele of the femoral hernia Laugier’s femoral hernia Laugier’s femoral hernia Laugier’s femoral hernia Laugier’s femoral hernia Laugier’s femoral hernia Laugier’s femoral hernia Laugier’s femoral hernia Laugier’s femoral hernia Hydrocele of the femoral hernia Hydrocele of the femoral hernia Laugier’s femoral hernia Cloquet’s hernia Dr. Mansoor Khan, MBBS, FCPS I, Resident Surgery Dr. Mohammad Zarin, FCPS, MRCS, FMAS Khyber Teaching Hospital Peshawar, Pakistan 2009 8 12

2. What is a femoral hernia ?

3. A femoral hernia is when abdominal Contents pass through a naturally occurring weakness called the femoral canal.

4. 3 rd Most common primary hernia 20% female hernias 5% of male hernias 2 times more common on right side 20% cases it is bilateral

5. Over-riding importance of femoral hernia.. ??

6. Strangulation narrowness and rigidity of the canal– 40% present as strangulation Truss does not help--- contraindicated

7. Femoral Canal…… ?

8. Potential space in medial portion of femoral sheath 1.25 cm long 1.25 cm wide Femoral ring covered by septum crurale (above) Saphenous opening covered by cribriform fascia (below)

9. Femoral ring…… ?

10. Lateral --- Femoral vein in femoral sheath Medial --- Lacunar ligament (Gimbernat’s) Anterior – Inguinal ligament (Poupart) Posterior – Iliopectineal ligament (Astley Cooper’s) Femoral ring

11. Elderly , multi-parous women Dragging pain & groin lump 40% present with strangulation Rare before puberty

12. Femoral hernia

13. Bilateral femoral hernia

14. Differential diagnosis..?

15. Inguinal hernia superio-medial while femoral is inferiolateral to pubic tubercle Inguinal hernia Femoral hernia

16. Saphena varex: positive cough impulse make them similar, fluid thrill, hum on auscultation, disappearance when supine and presence of varicose veins differentiates it from femoral hernia

18. Types of femoral hernia…?

19. Hydrocele of the femoral hernia sac when neck is blocked by contents or adhesions

20. Laugier’s femoral hernia Hernia through the lacunar ligament of Gimbernat’s

21. Narath’s femoral hernia sac behind the femoral vessels, occurs in hip dislocation

22. Cloquet’s hernia sac behind the pectineal fascia

24. Think as a Surgeon… WHEN TREATING FEMORAL HERNIA

25. Hurry up you got some work to do man….

26. Operate as soon as diagnosis is made-- strangulation

27. Remember Truss is contraindicated…..

28. High operation (McEvedy)

29. Low operation (Lockwood)

30. Inguinal operation (Lotheissen’s)

31. Laparoscopic repair (TEP—total extra-peritoneal)