Femoral Hernia In Children Research Articles

Femoral Hernia in Children as a Rare Pathology: A Retrospective Case Series

Abstract Background: Femoral hernias are uncommon groin pathology among children. The rarity of the pathology results in increased complications, delayed diagnosis and inappropriate inguinal exploration. In this study, we review our experience with this surgical entity over a 10-year period. Materials and Methods: The medical records of seven children who underwent femoral hernia repair between January 2010 and January 2021 at a single tertiary centre were retrospectively analysed. Reviewed data included demographics, pre-operative diagnosis, operative technique, complications and follow-up. Results: Seven children (5 females [71%] and 2 males [29%]) were operated due to femoral hernia. Median age was 8 years (range: 3–16 years). Four (57%) patients had right-sided femoral hernia and three (43%) were on the left side. The correct pre-operative diagnosis was obtained in three (42%) cases. The remaining four misdiagnosed cases were diagnosed as femoral hernia at the surgery. In all cases, the initial presentation was swelling; two (28%) had inguinal pain and three patients (42%) required emergency inguinal exploration due to suspected incarceration. All patients had repair of their hernia by open technique; the femoral canal was closed by mesh plug or Vicryl sutures. All patients were discharged without complications. No recurrence was detected and the median post-operative follow-up period was 24 months (range: 8–48 months). Conclusion: Femoral hernia is a challenging pathology and correct diagnosis requires a high index of clinical suspicion. In equivocal cases, ultrasonography and laparoscopy may be useful. Appropriate pre-operative diagnosis evades complications and delays in treatment. Regardless of the surgical approach recurrences and complications are very rare in children.

Femoral hernias: A paediatric surgical enigma

PurposeIn the paediatric population, femoral hernia (FH) represents an uncommon and often misdiagnosed pathology. This study aimed to review our experience with the management of FH in children. MethodsMedical records were retrospectively reviewed for all patients presenting to the paediatric surgical service in Ireland over a 15-year period (2004–2019), who were operated on for FH. Collected data included demographics, preoperative diagnosis, operative details, complications and follow-up. ResultsDuring the study period, n = 26 patients (n = 18 males) underwent FH repair, with a median age at surgery 6.9 years (range 3–16 years). During the same period n = 5693 patients underwent inguinal herniotomy, resulting in a FH to inguinal hernia (IH) ratio of 1:219 and a FH incidence of 0.45% of all groin hernias. The right side was affected in n = 18 (69.2%) cases and all cases were unilateral. A correct preoperative diagnosis was established in n = 16 (61.5%) cases, n = 8 (30.8%) cases were misdiagnosed as IH and the diagnosis was equivocal in 2 cases (7.7%). All operations were performed on an elective basis. In 3 patients from the misdiagnosed group, FH was found at first operation following negative groin exploration for IH. The remaining 5 patients underwent previous groin exploration for suspected IH and represented with clinical picture of groin hernia recurrence. All patients with a correct preoperative diagnosis underwent a FH repair via an inguinal or infra-inguinal approach. The content of the hernia sac was preperitoneal fat in n = 18 cases, lymph nodes in n = 2 cases, omentum in n = 1 and an empty sac in n = 1. There were no postoperative complications or recurrences. Median follow-up time was 6 weeks (range 0–2.5 years). ConclusionIn the paediatric population, FH is a rare pathology and can be a challenging diagnosis. FH is commonly misdiagnosed as IH and may require more than one operation to correctly identify and treat. A high index of suspicion of FH should be maintained in patients who have a negative groin exploration for IH in the setting of a clear pre-operative diagnosis of a groin hernia. FH should also be considered in the differential diagnosis when an IH appears to recur.

Femoral hernia in children: How to avoid misdiagnosis?

Background:Femoral hernias are an uncommon groin pathology among pediatric patients. Therefore, they are frequently misdiagnosed. In the present study, we review our experience with this rare surgical entity during the past 25 years.Methods:The medical records of 19 patients who underwent 22 femoral hernia repairs between January 1994 and December 2019 were retrospectively analysed.Results:Patients' age ranged from 2 to 12 years (mean age was 5. 5 years) with an approximately equal sex ratio (10 girls/9 boys). There were three bilateral cases identified separately. They were discovered and managed at different times. All the children were referred with a groin lump, but the correct pre-operative diagnosis was made in only 13 cases (59%). In the remaining cases, four were identified intraoperatively following negative exploration for a supposed inguinal hernia. The other five were found to have a femoral hernia 1 month to 12 months after ipsilateral inguinal hernia repair. All patients underwent elective surgery. The femoral canal was closed using either Lytle or McVay procedure. Recurrence occurred in only one patient 2 months after initial repair.Conclusion:Femoral hernias are often misdiagnosed. Pre-operative diagnosis can be obtained through careful clinical assessment. In equivocal cases, ultrasonography and laparoscopy could be useful. A correct pre-operative diagnosis will lead to suitable treatment, thus avoiding unnecessary reoperations and their related complications.

A case of a three-month-old female infant with incarcerated femoral hernia

Introduction. Femoral hernia in children is very rare and it appears in 0.2% of all hernias during childhood. It is three times more frequent in girls. The aim of this paper is to present a female infant with incarcerated femoral hernia. Case outline. A female infant aged three months was hospitalized with classical clinical signs of incarcerated left femoral hernia. After preoperative preparation, a transversal inguinal incision was performed on the left side and an incarcerated femoral hernia was confirmed with a torn and gangrenous left ovary and fallopian tube. Following adnexectomy, the hernia sac was ligated and resected and hernioplasty was made by the reconstruction of the Cooper?s ligament. Conclusion. A delayed surgical intervention for incarcerated femoral hernia in a female can result in a loss of the ovary and the fallopian tube, which may lead to serious consequences later in life.

Single-port laparoscopic percutaneous extraperitoneal closure of femoral hernia in children and adolescents: case series

BackgroundFemoral hernias are an often unexpected groin pathology during childhood. However, the pediatric surgeon has to be aware to diagnose femoral hernia and to repair this condition. This is the first report on laparoscopic percutaneous extraperitoneal closure of femoral hernia (LPEF) in children and adolescents.MethodsOver a 6-year period in a bi-institutional clinical study, we retrospectively identified six children and one young adult who underwent LPEF repair.ResultsFemoral hernia was laparoscopically confirmed in seven patients. Ages at surgery were 3, 5, 7, 7, 8, 8.5, and 18 years, respectively. In the first case, we combined laparoscopic diagnosis with open repair. In the consecutive six cases, hernias were repaired minimally invasively with the percutaneous extraperitoneal technique described below. During a follow-up between 6 years and 6 months, no recurrence was observed.Surgical techniqueFor LPEF, we percutaneously placed a peritoneal U-shape suture with integrated transfixation of the hernia sac, closed with an epifascial knot. We performed LPEF using two graspers. The peritoneum was percutaneously punctured with a venous cannula through which the suture was inserted. One grasper was inserted through the working channel of the laparoscope to invert the hernia sac into the abdominal cavity. A mini-grasping forceps inserted through the cannula retrieved the thread and completed LPEF.ConclusionWe demonstrate that single-port laparoscopic percutaneous extraperitoneal closure of femoral hernia is successful and quick in children and in adolescents.

Laparoscopic-Assisted Repair of Femoral Hernias in Children

Femoral hernias in children are rare, difficult to diagnose, and require a different treatment approach than the standard indirect inguinal hernia repair. Most femoral hernias in children are still repaired by using a conventional McVay technique. We have developed a simple, effective laparoscopic-assisted femoral hernia repair that avoids opening the inguinal canal in children. A 5-mm trocar is placed in the umbilicus, and the femoral hernia is visualized intracorporeally via a 30-degree laparoscope. The laparoscope is then passed into the hernia sac, with the visual axis pointing anterior toward the skin. Guided by transillumination, a 1-cm skin incision is made over the hernia sac at the upper thigh; the hernia sac is identified and dissected free from surrounding tissue. The sac is then grasped within the abdomen, inverted, twisted, and an endoscopic tie is placed at its neck. The defect between the medial pectineal and inguinal ligaments is closed externally with an absorbable suture. The described technique was successfully used on 3 boys, each with right femoral hernias (age 4-11; mean = 7). On 6-month follow-up, all patients had excellent cosmetic results with minimal scars and no recurrence. Laparoscopic-assisted femoral hernia repair is straightforward, efficient, and avoids dissection of the inguinal canal, thereby circumventing any risk of injury to the vas deferens and spermatic vessels. Although these early results are encouraging, more patients and longer follow-up are necessary to substantiate our technique.

A new minimally invasive technique for the repair of femoral hernia in children: About 13 laparoscopic repairs in 10 patients

Background Femoral hernias in children are rare and often misdiagnosed. The classic treatment is through an open anterior approach. Since the advent of laparoscopic treatment of inguinal hernia in children, laparoscopy has been proposed to offer an accurate diagnosis and treatment, especially in case of recurrent hernia or bilateral disease. This review was undertaken to report our experience with the primary laparoscopic diagnosis and treatment of pediatric femoral hernias and to investigate its safety and feasibility. Methods All cases of pediatric femoral hernia in a consecutive series of children treated laparoscopically for groin hernias in a single institution over a 7-year period (2001-2007) were identified and studied for patient characteristics, presentation, pre- and perioperative findings, details of the operative repair, and postoperative outcome. Results Out of a prospectively studied series of 462 laparoscopic pediatric inguinal hernia repairs in 389 patients, 13 femoral hernias were treated in 10 patients (6 boys), with a mean age of 71/2 years (range, 1.7-12). The preoperative diagnosis of femoral hernia was accurate in 7 patients. Seven femoral hernias were exclusively right sided; 3 were bilateral. All 13 femoral hernias were successfully treated by a standardized transabdominal laparoscopic approach with the use of three 3.5-mm trocars. All patients were treated in a day care setting. No postoperative complications occurred. No recurrences were seen until the present time, with a mean follow-up of 31/2 years. Conclusions Laparoscopy provides a straightforward, accurate diagnosis for the rare and often missed pediatric femoral hernias. The new technique described offers a safe and efficient minimally invasive anatomical repair of the crural orifice in children, even when not suspected preoperatively. The laparoscopic diagnosis of 13 femoral hernias from a cohort of 462 laparoscopic groin hernia repairs (2.8%) may suggest a higher prevalence rate of this unusual type of hernia in children than earlier described in literature.

Two Cases of Femoral Hernia in Children

Two Cases of Femoral Hernia in Children

Femoral hernias in children at the Olabisi Onabanjo University teaching Hospital, Sagamu, Nigeria

To ascertain the diagnostic accuracy and outcome of surgical treatment in Nigerian children referred for paediatric surgical opinion at the Olabisi Onabanjo University Teaching Hospital, Sagamu, South-west Nigeria. A retrospective review of our practice experience over a 15-year period; between January, 1989 and December, 2003. The Olabisi Onabanjo University Teaching Hospital (OOUTH), serves as a referral centre for other government and private hospitals in and around the Ogun State, South-west Nigeria. The OOUTH, though a tertiary medical centre also receives patients who present directly at the General Out-Patient Clinics and the Emergency Units of the hospital. The catchment population is estimated at 7.5 million. The medical records of all patients under 14 years of age with a final diagnosis of femoral hernia who presented between January, 1989 and December, 2003 were reviewed. The age, sex, mode of presentation, findings at surgery, procedure performed, immediate post-operative and 12 months follow-up details were recorded. Seven of 1,213 (0.58%) patients with groin hernias within the study period had femoral hernias; four (57%) were girls and three (43%) were boys. Age range was 3 to 9 years. The mode of presentation in all the children was recurrent lump in the groin. Five patients (71%) had right sided lump while the lump was on the left side in two of the patients. The duration of symptoms ranged from two years to eight years. The provisional diagnosis by the referring general practitioners and paediatricians were incorrect in all seven patients. Five patients (71 %) were correctly diagnosed preoperatively by the attending surgeon while two were thought to be inguinal hernias. The diagnosis of femoral hernia remains a challenging problem in childhood because of its rarity and similar clinical presentation as inguinal hernia.

Childhood femoral hernia: a commonly misdiagnosed condition.

Femoral hernia is a rare surgical entity in the paediatric age group. The diagnosis is still a challenging issue. The aim of our study was to review our experience with femoral hernias in children during the past 21 years. We reviewed retrospectively the medical records of all patients who underwent femoral hernia repair in our institution between 1980 and 2000. Thirty-eight children (20 females, 18 males) with the median age of 5.5 years underwent 42 femoral hernia repairs over a 21-year period. Correct preoperative diagnosis was obtained in 20 (53%) cases. Of the 18 (47%) misdiagnosed cases, 11 were found to have a femoral hernia at negative exploration for a clinically diagnosis of inguinal hernia and 7 were found to have a femoral hernia 1 week to 18 months (mean 2.5 months) post repair of a presumed inguinal hernia. Median follow-up time was 12 years (range, 6 months-22 years). Recurrent femoral hernias occurred in five (13%) patients 6 months to 3 years (mean 13.5 months) after initial hernia repair. This study shows that femoral hernia is still a commonly misdiagnosed condition. A correct preoperative diagnosis will lead to appropriate surgical management, thus avoiding unnecessary morbidity and preventing unnecessary reoperations.

The Importance of Femoral Hernia in Children

The Importance of Femoral Hernia in Children

Femoral hernia in children

Background/Purpose : Femoral herniae are uncommon in children and easily misdiagnosed. To evaluate performance with femoral hernia in children, the authors reviewed their experience for the past two decades. Methods : All patients under 15 years of age with femoral hernia (January 1977 to January 1998) were reviewed. Age, gender, presentation, surgical findings and procedure, and previous repair were recorded. Results : There were nine girls (53%) and eight boys (47%). Age range was 2 to 15 years. Thirteen were right side (77%), three were left side (18%), and one was bilateral (6%). All presented with a recurrent lump in the groin, one with incarceration. Duration of symptoms ranged from 1 day to 3 years (median, 3 months). Six cases were diagnosed correctly preoperatively (35%); the others were thought to be either an inguinal hernia or recurrent inguinal hernia. Conclusions : Femoral hernia in childhood is a challenging clinical problem because of its rarity and similar clinical presentation as indirect inguinal hernia. The frequency with which an incidental indirect inguinal hernia sac or patent processus vaginalis can be found at surgery can perpetuate a misdiagnosis. The absence of an expected indirect inguinal hernia sac or an apparent recurrence of an indirect inguinal hernia should lead to consideration of a possible femoral hernia.

Reappraisal of femoral hernia in children

Femoral hernias are rare in children, accounting for fewer than 1 per cent of all paediatric groin hernias. Misdiagnosis is common and a source of complications. There is no consensus on the age and sex distribution or the optimum method of repair. A personal experience of four children with femoral hernia is reported together with an institutional review of a further ten hernias encountered during the past 11 years. Peak incidence was between 5 and 10 years of age. Misdiagnosis was common, partly because of the variability in presenting symptoms and signs. In this series, boys were more commonly affected but a literature review indicated a similar sex incidence. A femoral hernia should be positively excluded if the operative findings at inguinal exploration are inconsistent with the preoperative signs and in any child with a suspected recurrent inguinal hernia. Excision of the sac and repair of the femoral canal is curative.

Reappraisal of femoral hernia in children

Reappraisal of femoral hernia in children

Femoral hernia in children

SummaryFemoral hernia is rare in children. Unfamiliarity with the occurrence of this condition may lead to incorrect diagnosis and delayed treatment. This mistake can be obviated by careful clinical examination.

Femoral hernias in children: P. Anderson, J.Z. Jona, M. Glicklich, et al. Arch Surg 122:950–951, (August), 1987

Femoral hernias in children: P. Anderson, J.Z. Jona, M. Glicklich, et al. Arch Surg 122:950–951, (August), 1987

Femoral hernia in children

International Journal of Clinical PracticeVolume 41, Issue 2 p. 618-618 Clinical Study Femoral hernia in children N V Srini FRCS (Ed), N V Srini FRCS (Ed) Department of Surgery, South Cleveland Hospital, MiddlesbroughSearch for more papers by this authorT Duncan FRCS (Ed), T Duncan FRCS (Ed) Department of Surgery, South Cleveland Hospital, MiddlesbroughSearch for more papers by this author N V Srini FRCS (Ed), N V Srini FRCS (Ed) Department of Surgery, South Cleveland Hospital, MiddlesbroughSearch for more papers by this authorT Duncan FRCS (Ed), T Duncan FRCS (Ed) Department of Surgery, South Cleveland Hospital, MiddlesbroughSearch for more papers by this author First published: 01 February 1987 https://doi.org/10.1111/j.1742-1241.1987.tb08071.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume41, Issue2February 1987Pages 618-618 RelatedInformation

Femoral hernia in children: S. Schulze and P.F. Schmidt. Z Kinderchir 40:287–288, (October), 1985

Femoral hernia in children: S. Schulze and P.F. Schmidt. Z Kinderchir 40:287–288, (October), 1985

Femoral Hernia in Children

The records of 26 children with femoral hernia are reviewed. In five patients, inguinal herniotomy had been performed previously. The correct diagnosis was made preoperatively in 7 (27%) of the cases only. The operation included a repair narrowing the femoral canal in all but 5 cases. At follow-up 1/2-19 1/2 years no recurrence was found. The importance of a careful pre- and peroperative examination is emphasized.

Femoral Hernia in Children

During a period of ten years, 20 children with femoral hernias were treated at Alder Hey Children's Hospital, Liverpool, England. Unfamiliarity with the occurrence of femoral hernias in children resulted in a correct diagnosis in only three (15%) of the 20 cases by the referring physician and in only 13 (65%) of the cases by the first surgeon to see the child. Misdiagnosis included inguinal hernia (four cases), lymphadenitis (two cases), and lymphangioma (one case). In two cases, misdiagnosis resulted in mistreatment; one child had the wrong operation performed, and delay in surgery in another resulted in strangulation of the omentum in the hernial sac. Treatment is by operation, which, despite the wide variety of procedures employed, was successful in 18 of the 20 cases. The two recurrences were due to the performance of inadequate operations; recurrence was really persistent, as the femoral pad of fat was removed but the sac was missed. The positive identification of the hernial sac is imperative.