[Femoral hernias: repair techniques]

Femoral hernias are diagnosed in more than 50% of cases during strangulation. This is predominantly a female disorder. Given the configuration of the femoral ring itself, these hernias are difficult to diagnose and carry a high risk of strangulation (risk multiplied by 10) and visceral pain. Postoperative morbidity and mortality after intervention in an emergency situation surpasses 10%. A diagnosed femoral hernia should therefore always be operated. This type of hernia is rarely associated with an inguinal hernia and the femoral approach is recommended. If the superficial ring is less than 15 mm in diameter, the Lytle procedure is recommended; in all other cases, one must avoid generating excessive tension on the tissues and thus increasing the risk of recurrence. The modified Lichtenstein, Plug(R), or transabdominal preperitoneal (TAPP) techniques are best in this situation. In males, femoral hernias are rare and in more than half the cases are associated with an inguinal hernia. The abdominal wall-strengthening technique should be used to treat all the hernial rings so that an inguinal hernia does not occur postoperatively. Here tensionless techniques are also preferred, a McVay repair respecting the long incision on the sheath of the abdominal rectus, the modified Lichtenstein procedure, the Rives technique, or video-assisted techniques. During hernial strangulation, even if using mesh repair does not seem to increase the risk of sepsis, herniorrhaphy repair should be preferred.