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Inguinal hernia, hydrocele, and other hernias of the abdominal wall
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Sophia Abdulhai, Todd A. Ponsky
All layers are incised, exposing the femoral hernia sac. Note the margins of the femoral canal as: Anterior – inguinal ligament (lower margin of external oblique aponeurosis)Posterior – pectineal ligament, fascia overlying pectineusMedial – lacunar ligament (of Astley Cooper)Lateral – femoral vein
Answers
Published in Thomas Hester, Iain MacGarrow, Surgical SBAs for Finals with Explanatory Answers, 2018
Femoral hernias are more common in females, however inguinal hernias are still more frequent than femoral. The boundaries of the femoral canal are: anteriorly: the inguinal ligamentmedially: the sharp edge of the lacunar part of the inguinal ligamentlaterally: the femoral veinposteriorly: the pectineal ligament.
Hernia and hydrocele
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
The infrainguinal approach is the preferred method for elective repair. The transinguinal approach involves dissecting through the inguinal canal and it carries the risk of weakening the inguinal canal. McEvedy’s approach is preferred in the emergency setting when strangulation is suspected. This allows better access to and visualisation of bowel for possible resection. Repair is performed either by suturing the inguinal ligament to the pectineal ligament (Cooper’s ligament repair) using strong non-absorbable sutures or by placing a mesh plug in the femoral ring. With either technique care should be taken to avoid any pressure on the femoral vein. Bassini’s repair (conjoint tendon is approximated to the inguinal ligament) is a type of tension herniorrhaphy for the management of direct inguinal hernia.
De Garengeot hernias. Over a century of experience. A systematic review of the literature and presentation of two cases
Published in Acta Chirurgica Belgica, 2022
Michail Chatzikonstantinou, Mohamed Toeima, Tao Ding, Almas Qazi, Niall Aston
The femoral canal is the most medial compartment of the femoral sheath, which is bordered anterosuperiorly by the inguinal ligament, medially by the lacunar ligament, laterally by the femoral vein and posteriorly by the pectineal ligament. It contains fat lymphatics and the lymph node of Cloquet. A large mobile caecum that extends into the pelvis is the usual reason for the appendix to enter the hernia sac into the femoral ring [13–15]. The abnormal low position of the bowel creates a mass effect that pushes the appendix into the femoral canal, while an abnormal embryological rotation of the gut increases the probability of appendiceal herniation. Intraoperative findings of normal non-inflamed appendix favour the theory of herniation of the appendix and subsequent inflammation rather than incarceration of an already inflamed appendix. The tight rigid femoral ring acts as an entrance to an anatomically confined space for strangulation, inflammation and, eventually, vascular congestion, necrosis and perforation of the appendix.