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 Mansoor Khan 2010 6 01

2. “ Protrusion of a viscus or part of a viscus through an abnormal opening in the wall of its containing cavity”

3. ETIOLOGY

4. Hernial sac: diverticulum of the peritonium (mouth, neck, body, fundus)

5. NECK BODY FUNDUS

6. Coverings: derived form the layers of the abdominal wall

7. Contents: omentum, intestine, portion of a viscus, appendix, meckel’s diverticulum, bladder Sliding Hernia Fallopian tube Omentocele Enterocele

8. Reducible: contents can be reduced back to abdominal cavity

9. Irreducible: contents can not be reduced to the abdominal cavity—risk of strangulation

10. Strangulated: blood supply to the contents is compromised leading to gangrene in 6 hours—emergency

11. Obstructed: the bowel lumen is obstructed without compromise of blood supply—usually go on to strangulation

12. Anatomy of inguinal canal

13. indirect inguinal hernia most common hernia. Most common in young. Direct hernia is most common in elderly. In adults 65% are indirect hernia, in 55% on right side

14. Ingiunial hernia in babies is due to patent processus vaginalis

15. Funicular Bubonocele Testicular

16. What is a femoral hernia ?

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

18. 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

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

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

21. Femoral Canal…… ?

22. 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)

23. Femoral ring…… ?

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

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

26. Femoral hernia

27. Bilateral femoral hernia

28. Differential diagnosis..?

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

30. 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

31. Types of femoral hernia…?

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

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

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

35. Cloquet’s hernia sac behind the pectineal fascia

36. Think as a Surgeon… WHEN TREATING FEMORAL HERNIA

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

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

39. Remember Truss is contraindicated…..

40. High operation (McEvedy)

41. Low operation (Lockwood)

42. Inguinal operation (Lotheissen’s)

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