Femoral Hernioplasty Research Articles

EP58 - Gangrenous appendicitis in an incarcerated femoral hernia: A rare case of De Garengeot Hernia

Abstract Aims To present a rare case of gangrenous appendicitis within an incarcerated femoral hernia, discussing its clinical background and highlighting the challenges in its diagnosis and surgical management. Methods We detail a 74-year-old female with a painful, non-reducible groin mass. A CT abdomen pelvis revealed a right femoral hernia with acute reactive inflammatory changes, with no comment made on the appendix (Figure 1 and 2). Emergency open femoral hernioplasty and laparoscopic appendectomy were performed. Results Intraoperatively, a femoral hernia with a gangrenous appendicitis were identified. The appendix was reduced into the abdominal cavity to allow for better evaluation of its base. A laparoscopic appendectomy was performed after identifying the healthy base (Figure 3), followed by a femoral hernioplasty. This case sheds light on the rarity not only of the De Garengeot hernia which is defined by the presence of the vermiform appendix within the femoral hernia sac, but also even rarer the finding of a gangrenous appendix within the sac, with a reported incidence from 0.08-0.13% in cases of acute appendicitis. The case emphasizes the importance of considering an acute appendicitis and its complications within a femoral hernia as a differential diagnosis of painful groin masses with raised inflammatory markers. Conclusion Given the scarcity of literature on the surgical management of acute appendicitis in De Garengeot hernias, this case contributes valuable insights. The absence of established guidelines underscores the need for further exploration of optimal surgical strategies in such cases. Our report aims to enhance awareness of this rare presentation and facilitate future discussions on its management.

What are the effects of antibiotic prophylaxis for preventing wound infection in adults undergoing open inguinal or femoral hernioplasty surgery?

What are the effects of antibiotic prophylaxis for preventing wound infection in adults undergoing open inguinal or femoral hernioplasty surgery?

Preperitoneal femoral hernioplasty: an "umbrella" technique.

Tension-free inguinal mesh-plug hernioplasty is well established. However, femoral hernia repair remains challenging and controversial. We aimed to evaluate a preperitoneal approach of tension-free hernioplasty for femoral hernia upon the anatomy rationality. A prospective study of 62 patients between October 1999 and June 2011 received femoral hernioplasty in our hospital. This repair method involved a preperitoneal approach accomplished under regional or local anesthesia with mesh and plug; the emphasis was put on fulfilling the abdominal defect, i.e., the myopectineal orifice, with the plug flattened like an "umbrella", above the femoral ring but not to fill the femoral ring. All cases receiving preperitoneal tension-free hernioplasty had a smooth recovery. There were no severe complications, and no recurrences were detected within a 0.5- to 4-year follow-up. No specific restrictions with regard to activity were placed on the patients after surgery. All cases were able to return to normal life, including work, within 2 weeks. The preperitoneal tension-free hernioplasty may be a more effective method of femoral hernia repair; meanwhile, we must re-understand the anatomy of femoral hernia correctly so as to restore the anatomic and physiologic functions at this region optimally.

Incidental finding of a malignant tumour in an inguinal hernia sac.

Metastatic carcinomas in hernial sacs are rare, especially in bilateral femoral hernias. Here we describe a 63-year-old female patient with metastatic carcinoma in bilateral femoral hernias. She was diagnosed incidentally during femoral hernioplasty. A diagnostic laparoscopy revealed metastatic nodules in the abdominal cavity. Subsequently, the patient underwent a laparotomy that did not show any evidence of primary lesions. A chemotherapeutic pump was implanted into the abdominal cavity during surgery for postoperative chemotherapy. The chemotherapy regimen included 5-Fu, hydroxycamptothecin, and pirarubicin, supplemented with high agglomerative staphylococcin. Forty-one months after surgery her disease was stable and no abdominal cavity, pelvis, liver or lung metastases were observed. Therefore, we suggest that abnormal hernial sacs may be the first clue to an underlying cancer, and should be sent for histological examination. Furthermore, if a patient is found to have metastatic abdominal cancer with no evidence of primary lesions, they would probably benefit from postoperative chemotherapy. This can be delivered using a chemotherapeutic pump implanted during surgery.

Femoral Hernia: A Review of the Clinical Anatomy and Surgical Treatment

Purpose: Femoral hernia is a kind of ventral hernia that surgeons commonly encounter, second in frequency only to inguinal hernia. Femoral hernias often require emergency surgery because of incarceration or strangulation of the intestine. In addition, intestinal resection may need to be considered based on intestinal viability. Definitive preoperative diagnosis and strategic planning for surgery are thus important. The surgeon should consider the operation in the context of the clinical anatomy of the abdominal cavity. Therefore the essence of the clinical anatomy and treatment of femoral hernia is described. Methods: The medical records of 38 patients who underwent femoral hernia repair between March 2006 and November 2011 were retrospectively analyzed. Results: Femoral hernioplasty was performed with original mesh repair or Ruggi’s repair plus iliopubic tract repair (or Bassini’s repair). The mean patient age was 76.7 years, and a female predominance was apparent. Twenty-four patients underwent emergency surgery with a diagnosis of incarcerated femoral hernia. Nine patients showed intestinal strangulation and underwent resection of the small intestine. Four patients developed complications. One patient died due to aspiration pneumonia. No recurrences were encountered after 6 months to 6 years of follow-up. Conclusion: Femoral hernia is an important surgical condition with high rates of incarceration/strangulation and intestinal resection. Correct preoperative diagnosis of femoral hernia and a strict operative strategy are important. The original mesh repair is effective and easy to perform.

Is endoscopic totally extraperitoneal hernioplasty justified for the repair of groin hernia in female patients?

Groin hernia is an uncommon surgical pathology in females. The efficacy of the endoscopic approach for the repair of female groin hernia has yet to be examined. The current study was undertaken to compare the clinical outcomes of female patients who underwent open and endoscopic totally extraperitoneal inguinal or femoral hernioplasty (TEP). From July 1998 to June 2004, 108 female patients who underwent elective repair of groin hernia were recruited. The patients were divided into TEP (n = 30) and open groups (n = 78) based on the type of operation. Clinical data and outcome parameters were compared between the two groups. The mean ages and hernia types were comparable between the two groups. All TEPs were successfully performed. The mean operative times were 52 min for unilateral TEP and 51 min for open repair. The difference was not statistically significant. Comparisons of the length of hospital stay, postoperative morbidity, pain score, and time taken to resume normal activities showed no significant differences between the two groups. A single patient in the TEP group experienced recurrence of hernia. The findings show equivalent postoperative outcomes after TEP and open repair of groin hernia in female patients. Because the wound scar after open repair is well concealed beneath the pubic hair and no superior clinical benefits are observed after TEP, open repair appears to be the technique of choice for the management of primary groin hernia in females. The TEP approach should be reserved for female patients with recurrent or multiple groin hernia.

Sutureless mesh-plug femoral hernioplasty

Background Prosthetic mesh groin hernioplasty is well established. We aimed to determine whether a sutureless mesh-plug repair of femoral hernias was a reliable proposition. Methods A prospective study of 42 patients undergoing femoral hernioplasty with a preformed three-dimensional mesh plug placed in the preperitoneal plane. Results There were no complications, and no recurrences were detected at a median follow-up of 2 years (range 2 to 44). Conclusions Preperitoneal mesh plug femoral hernioplasty appears to be universally applicable and deserves further evaluation.

Inguinal and femoral hernioplasty.

We have carefully analyzed the causes of recurrence in our 1,211 hernioplasties performed over a 22-year period. In addition to recording our overall recurrence rate, we have divided the hernias into four categories based upon the pathologic anatomy and then studied the causes of recurrence for each group. We have suggested a formula for the uniform reporting of more short-term follow-up studies so that more meaningful data will be available to surgeons in the future. Our overall recurrence rate is now 3.5%, but projects to 4.2% at the end of 25 years.

Inguinal and Femoral Hernias

Surgical repair of an inguinal hernia is a frequently performed operation. Ideally, a hernia should be permanently cured by one operation and its repair attended by minimum morbidity. But there is much to go wrong after a hernia repair; the atrophied testicle, the recurrent hernia, and other problems are seen all too often. This study evaluates our experience with the repair of inguinal and femoral hernias, tabulates the complications encountered in groin surgery, and considers the causes of recurrent hernias. Clinical Material The records of all patients undergoing inguinal or femoral hernioplasty at Mary Hitchcock Memorial Hospital between Jan 1, 1950, and Dec 31, 1959, were reviewed. During this period 1,162 patients underwent 1,286 operations in which 1,416 different hernias were repaired by the permanent and resident staff of this hospital. Approximately 40% of the patients had adequate long-term follow-up data in their records which, in this institution, include the

Inguinal and Femoral Hernioplasty in the Adult

Inguinal and Femoral Hernioplasty in the Adult

Inguinal and femoral Hernioplasty: The Evaluation of a Basic Concept

Inguinal and femoral Hernioplasty: The Evaluation of a Basic Concept

Inguinal and Femoral Hernioplasty

Inguinal and Femoral Hernioplasty

Femoral hernioplasty

Femoral hernioplasty