Hernia of De Garengeot an up to date of diagnosis, initial management and treatment: a narrative review and a case study report / Hernia de De Garengeot: diagnóstico, manejo inicial y tratamiento actualizados: una revisión narrativa y un informe de estudio de caso

INTRODUCTION A De Garengeot hernia is defined by a femoral hernia containing the appendix. Acute appendicitis within a femoral hernia is an extremely rare surgical presentation and occurs in only 0.08-0.013% of cases cited in the literature and 5 to 15% of all femoral hernias. CASE PRESENTATION A 53-year-old woman presented to the emergency room of our hospital in our ward with acute onset of a right-sided inguinal swelling that occurred earlier that day after performing a heavy lift. Her examination revealed acute appendicitis contained within an incarcerated right femoral hernia. The patient underwent laparoscopic appendectomy with open femoral hernia repair. Intraoperatively, the tip of the appendix was incarcerated within the hernial sac. She was removed through the open inguinal incision after the base of the appendix has been divided laparoscopically. The final pathology showed acute inflamed appendicitis with no evidence of neoplasm. DISCUSSION Physicians should be aware of the rare extent of an unusual presentation of appendicitis such as well as surgical options for treatment. The literature does not conclude on a gold standard for the method of approach. CONCLUSION De Garengeot's hernia remains a rare and unusual surgical presentation of femoral hernia, and the complication of the case by incarceration leading to acute appendicitis provides a challenging surgical approach that should be personalized for each patient

De garengeot's hernia: case report

ABSTRACT Introduction: De Garengeot hernia is an entity mainly diagnosed intraoperatively. It is more frequently observed in women and is defined as the presence of the vermiform appendix inside to femoral hernia. Most femoral hernias are identified based on clinical diagnosis, but diagnostic imaging is necessary for confirmation. Ultrasound, for example, is a valuable tool to characterize the anatomy of the hernia and its content, and to establish surgical planning. Case presentation: A 75-year-old woman attended the general surgery department of a high complexity hospital in Bogotá, Colombia, due to a painful mass in the right inguinal region. The initial ultrasound study showed a femoral hernia containing the incarcerated appendix and periappendiceal fluid in the hernial sac. The patient developed chronic appendiceal inflammation, so she underwent femoral hernia repair with mesh and appendectomy without complications, achieving a satisfactory recovery. Conclusion: Clinical examination may be sufficient to confirm the presence of a hernia in a large number of cases when the diagnostic approach involves the search of inguinal masses with pain. However, to facilitate surgical planning, diagnostic imaging, especially ultrasound with high-resolution transducers, is the primary tool to characterize the type of hernia and the contents of the hernial sac.

RESUMEN Introducción. La hernia de Garengeot es una entidad cuyo diagnóstico es principalmente intraoperatorio, se presenta con mayor frecuencia en mujeres y corresponde al hallazgo del apéndice cecal contenido en una hernia femoral. La mayoría de las hernias femorales se identifican mediante diagnóstico clínico, pero para su verificación es importante hacer una valoración con imágenes diagnósticas: el ultrasonido, por ejemplo, es una herramienta valiosa para caracterizar la anatomía de la hernia y su contenido, y para establecer el planeamiento quirúrgico. Presentación de caso. Mujer de 75 años quien asistió al servicio de cirugía general de un hospital de alta complejidad de Bogotá, Colombia, por presentar una masa dolorosa en región inguinal derecha. El estudio ecográfico inicial mostró una hernia femoral conteniendo el apéndice cecal con septos internos que separaban el líquido dentro del saco herniario. La paciente presentó inflamación crónica en el apéndice, por lo que se le practicó herniorrafía femoral con malla y apendicectomía sin complicaciones y con las cuales tuvo una recuperación satisfactoria. Conclusiones. El examen clínico puede ser suficiente para confirmar la presencia de una hernia en un gran número de casos cuando se hace el abordaje diagnóstico de masas inguinales con presencia de dolor; sin embargo, las imágenes diagnósticas, especialmente la ecografía con transductores de alta resolución, constituyen la herramienta de primera línea para caracterizar el tipo de hernia y el contenido del saco herniario, lo que facilita la planeación quirúrgica.

Femoral hernia: uncommon, but associated with potentially severe complications / Hérnia femoral: incomum, mas associada a complicações potencialmente graves

ABSTRACT Background: Although the laparoscopic access is becoming the preferable treatment for femoral hernia, there are only few studies on this important subject. Aim: To assess the outcomes of the totally extraperitoneal laparoscopic (TEP) access in the treatment of femoral hernia. Methods: Data of 62 patients with femoral hernia who underwent herniorrhaphy were retrospectively reviewed. The diagnosis of femoral hernia was established by clinical and/or imaging exams in 55 patients and by laparoscopic findings in seven. Results: There were 55 (88.7%) females and 7 (11.3%) males, with female to male ratio of 8:1. The mean age was of 58.9±15.9 years, ranging from 22 to 92 years. Most patients (n=53; 85.5%) had single hernia and the remaining (n=9; 14.5%) bilateral, making a total of 71 hernias operated. Prior lower abdominal operations were recorded in 21 (33.9%) patients. Conversion to laparoscopic transabdominal preperitoneal procedure was performed in four (6.5%). Open herniorrhaphy was needed in two (3.2%), one with spontaneous enterocutaneous fistula in the groin region (Richter's hernia) and the another with incidental perforation of the adjacent small bowel that occurred during dissection of hernia sac. There was no mortality. Conclusion: Femoral hernia is uncommon, and it may be associated with potentially severe complications. Most femoral hernias may be successfully treated with totally extraperitoneal laparoscopic access, with low conversion and complication rates.

RESUMO Racional: Embora o acesso laparoscópico esteja se tornando o tratamento preferencial para a hérnia femoral, poucos são os estudos sobre esse importante assunto. Objetivo: Avaliar os resultados do acesso laparoscópico totalmente extraperitoneal no tratamento da hérnia femoral. Métodos: Os dados de 62 pacientes com hérnia femoral que foram submetidos a herniorrafia foram revisados ​​retrospectivamente. O diagnóstico foi estabelecido por exames clínicos e/ou de imagem em 55 pacientes e por achados laparoscópicos em sete. Resultados: Havia 55 (88,7%) mulheres e 7 (11,3%) homens, com proporção feminino/masculino de 8: 1. A média de idade foi de 58,9±15,9 anos (22-92). A maioria (n=53, 85,5%) apresentava hérnia única e o restante (n=9, 14,5%) bilaterais, perfazendo um total de 71 hérnias femorais operadas. Operações prévias no abdome inferior foram registradas em 21 (33,9%) pacientes. A conversão para procedimento pré-peritoneal transabdominal laparoscópico foi realizada em quatro (6,5%). Herniorrafia aberta foi necessária em dois pacientes (3,2%), um com fístula enterocutânea espontânea na região da virilha (hérnia de Richter) e o outro com perfuração incidental do intestino delgado adjacente que ocorreu durante a dissecção do saco herniário. Não houve mortalidade. Conclusão: A hérnia femoral é incomum e pode estar associada a complicações potencialmente graves. A maioria das hérnias femorais pode ser tratada com sucesso através do acesso laparoscópico totalmente extraperitoneal, com baixas taxas de conversão e complicações.

Hernia de Garengeot: presentación de un caso y revisión de la literatura / De Garengeot hernia: a case report and literature review

INTRODUCTION: Femoral hernias have a high risk of strangulation or obstruction, and their acute presentations are associated with a high risk of mortality, occurring in up to 60% of cases with complications. The presence of the appendix within the femoral sac has been described in a maximum of 1% of cases, which has been called Garengeot hernia, but only 0.08% with concomitant appendicitis. CASE REPORT: Woman 56 years old, cholecystectomized, with no other relevant history, 5 months of evolution, right femoral region volume increase, consultation for 24 hours of evolution of habitual pain exacerbation, CT scan showing complicated hernia, with appendix inside of the hernial sac. The right inguinal approach is performed, the cecal appendix is the only content within the hernial sac, with signs of acute appendicitis, appendectomy and hernia repair with Prolene mesh. Diagnosis is confirmed with biopsy. DISCUSSION AND CONCLUSION: Acute appendicitis within De Garengeot's hernia is extremely rare and often difficult to diagnose. The diagnosis of a femoral hernia appendicitis is often obscured by nonspecific clinical findings that indicate a complicated hernia. Computed tomography may be useful to definitively diagnose acute appendicitis contained within a femoral hernia. It is important to always consider De Garengeot hernia as a differential diagnosis in patients with inguinal mass of acute pain, so as not to delay its detection and management.

Femoral hernia containing the right fallopian tube: a rare finding / Hérnia femoral contendo a trompa de falópio direita: um achado raro

Abstract Femoral hernias comprise a small proportion of all groin hernias. They are more common in women and have a high rate of incarceration and strangulation, leading to emergency repair. A 61-year-old female patient was admitted to the emergency department complaining of a 2-day painful lump in the right groin, that had become more intense in the last 24 hours. Physical examination suggested the presence of a strangulated femoral hernia, and the patient underwent emergency surgical repair. Intraoperatively, the right fallopian tube was observed in the hernia sac. Since there were no signs of ischemia, the tube was reduced back into the pelvic cavity and the hernia was repaired. The postoperative period was uneventful, and the patient was discharged without complications, 3 days after surgery.

Resumo As hérnias femorais representamuma pequena fração de todas as hérnia da região inguinal. Elas são mais comuns entre as mulheres e estão associadas a elevadas taxas de complicações, como encarceramento e estrangulamento, com necessidade de cirurgia urgente. Uma paciente do sexo feminino, de 61 anos, recorreu ao serviço de emergência por quadro de dor e tumefação da região inguinal direita com 2 dias de evolução e agravamento nas últimas 24 horas. O exame objetivo sugeria a presença de uma hérnia femoral encarcerada, e a paciente foi submetida a cirurgia urgente. Intraoperatoriamente, confirmou-se o diagnóstico de hérnia femoral encarcerada, que continha a trompa de falópio direita no interior do saco herniário. Uma vez que a que a trompa não apresentava sinais de isquemia, o conteúdo da hérnia foi reduzido, e procedeu-se à sua reparação. O período pós-operatório decorreu sem intercorrências, e a paciente teve alta no 3° dia após a cirurgia.

Inflamed Appendix in an Incarcerated Femoral Hernia / Apéndice inflamado en una hernia femoral incarcerada

ABSTRACT The presence of appendicitis in an incarcerated femoral hernia is an extremely rare occurrence, known as De Garengeot's hernia, with potentially serious complications. An incarcerated femoral hernia was noticed intraoperatively, and the hernial sac, closely fused with femoral blood vessels, contained the phlegmonously inflamed vermiform appendix. Appendectomy and mesh hernioplasty were carried out. The postoperative period was uneventful.

RESUMEN La presencia de apendicitis en una hernia femoral incarcerada es una condición extremadamente rara, conocida como hernia de Garengeot, la cual presenta complicaciones potencialmente serias. Una hernia femoral incarcerada fue observada intraoperativamente, y el saco herniario, estrechamente fusionado con los vasos sanguíneos femorales, contenía el apéndice vermiforme con una inflamación flemónica. Se realizaron una apendicectomía y una hernioplastia con malla. El período postoperatorio se desarrolló sin problemas.

Features of multi-slice spiral CT examination of indirect and direct and femoral inguinal hernia in adults / 中华消化外科杂志

Objective To explore the features of multi-slice spiral computed tomography (MSCT) examination of indirect,direct and femoral inguinal hernia.Methods The retrospective cross-sectional study was conducted.The clinical data of 106 patients with indirect,direct and femoral inguinal hernia who were admitted to the First Affiliated Hospital of Xinxiang Medical University between December 2014 and August 2017 were collected.All the patients were diagnosed as inguinal hernia by MSCT examination and multi-planar reconstruction.Observation indicators:(1) sensitivity,specificity,positive and negative predictive values and diagnostic accordance rate of indirect,direct and femoral inguinal hernia by MSCT;(2) inguinal anatomic presentation in MSCT examination;(3) relationship between hernial sac and surrounding structures in MSCT examination;(4) hernia contents and quadrants of hernial sac in the quadrant partition with " cross intersect" method and complications.Count data were described as absolute number or percentage.Comparison of count data was done using the chi-square test with row multiplied by column.Results (1) Sensitivity,specificity,positive and negative predictive values and diagnostic accordance rate of indirect,direct and femoral inguinal hernia by MSCT:of 106 patients,66,22 and 18 were diagnosed as indirect hernia,direct hernia and femoral hernia with 70,27 and 20 hernial sacs respectively.Sensitivity,specificity,positive and negative predictive values of inguinal hernia by MSCT were respectively 95.7％,96.3％,98.5％,89.7％ in indirect hernia patients and 96.3％,95.7％,89.7％,98.5％ in direct hernia patients and 100.0％,100.0％,100.0％,100.0％ in femoral hernia patients,and diagnostic accordance rate of femoral hernia was also 100.0％.Diagnostic accordance rate of inguinal hernia was 95.9％,and correct index was 0.920.(2) Inguinal anatomic presentation in MSCT examination:transverse,coronal and sagittal imagings of inferior epigastric artery,inguinal ligament,musculus rectus abdominis,femoral vein and other anatomic structures can be identified,and internal ring of inguinal canal of 6 patients cannot be observed clearly.For relationship between internal ring of inguinal canal and inferior epigastric artery,coronal view was the best,transverse view was the next,and sagittal view was rarely observed.For relationship between inguinal ligament and hernial sac,sagittal view was the best,coronal view was also observed clearly by continuous planes,and transverse view was poor.The oblique coronal view was the best for the direct hernial triangle and internal ring of inguinal canal,and coronal view of femoral triangle was the best.The lateral crescent sign and quadrant partition of "ross intersect" method needed to be observed in transverse plane.(3) Relationship between hernial sac and surrounding structures in MSCT examination:indirect hernia entered into the inguinal canal through internal ring of inguinal canal,and hernial sac was located at the outside of inferior epigastric artery;direct hernia was out through triangle hernia,and hernial sac was located at the inside of inferior epigastric artery,92.6％ (25/27) patients were accompanied by lateral crescent sign.The indirect hernia and direct hernia went along the upper front of inguinal ligament;femoral hernia was out through femoral triangle hernia,and hernial sac was located at the lower back of inguinal ligament and the outside of the pubic tubercle.(4) The hernia contents and quadrants of hernial sac in the quadrant partition with "cross intersect" method and complications:the most common hernia content was small intestine,including partial patients with hernia content composed of various substances;indirect hernia contents included small intestine (35),mesentery (29),effusion (25),intraabdominal fat (9),colon (8) and ovary (1) in turn;direct hernia contents included small intestine (14),intraabdominal fat (11),effusion (6),mesentery (6),colon (3) and bladder (2) in turn;femoral hernia contents included small intestine (12),intraabdominal fat (8),effusion (3) and mesentery (2) in turn.There was a statistically significant difference in the hernia contents among indirect hernia,direct hernia and femoral hernia (x2=28.389,P＜0.05).The main hernial sac located at antero-external quadrant was respectively occurred in 70 hernial sacs of indirect hernia and 27 hernial sacs of direct hernia and 15 hernial sacs of femoral hernia,and 5 hernial sacs of femoral hernia were located at postero-external quadrant.There was a statistically significant difference in comparison of the quadrant partition with "cross intersect" method (x2 =78.904,P ＜ 0.05).The intestinal obstruction was respectively occurred in 8 patients with indirect hernia and 14 patients with direct hernia and 12 patients with femoral hernia,with a statistically significant difference (x2=26.674,P＜0.05).Conclusions Indirect hernia,direct hernia and femoral hernia have characteristic signs of imaging.MSCT can display precisely the anatomical details of inguinal region,which plays an important role in diagnosis and differential diagnosis of indirect hernia,direct hernia and femoral hernia,especially in display of hernia contents and diagnosis of complications,thus it can provide important information for evaluating risk and making operation plan.

Clinical efficacy of mesh repair via inguinal approach in acute femoral hernia / 中华消化外科杂志

Objective To investigate the clinical efficacy of mesh repair via inguinal approach in acute femoral hernia.Methods The retrospective cohort study was conducted.The clinical data of 48 patients with acute femoral hernia who were admitted to Huadong Hospital Affiliated to Fudan University between January 2007 and December 2016 were collected.Of 48 patients,29 undergoing hernia repair with polypropylene mesh and 19 undergoing hernia repair with suture were allocated into the study group and control group respectively.All the patients underwent hernia repair via inguinal approach.Observation indicators:(1) surgical and postoperative situations;(2) follow-up and survival situations.Follow-up was performed by outpatient examination and telephone interview to detect complications,hernia recurrence,survival situations at 1-,3-month and 1 year postoperatively for 1 year up to December 2017.Measurement data with normal distribution were represent as x±s and comparison between groups was done by the t test.Comparison of count data was analyzed using the chi-square test or Fisher exact probability.Results (1) Surgical and postoperative situations:patients in the 2 groups underwent successful incarcerated or strangulated acute femoral hernia repair.There were 3 and 4 patients receiving small bowel resection in the study group and control group respectively,with no statistically significant difference between groups (x2=1.50,P＞0.05).The operation time was respectively (82±16)minutes and (96± 13)minutes in the study group and control group,with statistically significant difference between groups (t =-2.94,P＜0.05).There was no femoral vascular injury in the 2 groups.The time of drainage-tube removal and duration of postoperative hospital stay were respectively (4.5 ± 1.6) days and (9±4) days in the study group and (3.9± 1.3)days and (10±4)days in the control group,with no statistically significant difference between groups (t =1.36,-0.33,P＞0.05).(2) Follow-up and survival situations:all the 48 patients were followed up for one year.No mesh infection was found in the study group.[ncisional infection was detected in 4 and 2 patients of the study group and control group respectively,with no statistically significant difference between groups (x2 =0.11,P＞ 0.05).Patients with incisional infection were cured after incision open drainage.Two and 2 patients had postoperative chronic pain in the study group and control group respectively,with no statistically significant difference between groups (x2 =0o 20,P＞0.05).The 4 patients had mild intermittent pain,without special treatment.There were no seroma occurred in the 2 groups.Hernia recurrence was occurred in 0 aud 5 patients of the study group and control group respectively,with statistically significant difference between groups (x2 =8.52,P＜0.05).There were 2 and 1 patient dead in the study group and control group respectively,with no statistically significant difference between groups (P ＞ 0.05).Conclusions Hernia repair with Polypropylene mesh via inguinal approach in acute femoral hernia is safe and feasible.Compared to suture repair,it can not only shorten operation time and reduce hernia recurrence,but also had no mesh infection and cannot iucrease postoperative complications.

Hernia femoral de Littré estrangulada: reporte de caso clínico / Strangulated Littré femoral hernia: case report

Resumen Objetivo: Presentar un caso de hernia femoral de Littré estrangulada. Caso clínico: Hombre de 86 años, que consultó por cuadro de dolor abdominal periumbilical postraumático de 4 días de evolución que se acompañaba de vómitos y ausencia de deposiciones con tránsito de gases conservado. Destacaba al examen masa dolorosa e indurada de 3 cm de diámetro no reductible bajo arcada inguinal derecha. Se realizó una herniorrafia femoral con abordaje preperitoneal, identificando una hernia de Littré estrangulada y realizándose una resección intestinal más reparación tisular del defecto herniario. Conclusión: Las hernias de Littré femorales son una entidad extremadamente rara y el manejo quirúrgico óptimo no está establecido.

Abstract Objective: To present a case of strangulated Littré femoral hernia. Clinical case: 86 years old man with 4 days of post-traumatic periumbilical abdominal pain accompanied by vomiting and absence of stools with gas transit preserved. Examination highlighted a painful and indurated mass of 3 cm in diameter that it was not reducible below right inguinal arch. A femoral hernia repair with preperitoneal approach was performed by identifying a strangulated Littré hernia performing bowel resection and tissue repair of the hernia defect. Conclusion: Littré femoral hernias are an extremely rare entity and optimal surgical management is not established.

Intervenciones en hernias inguinocrurales: bilateralidad y recidiva hemiaria. Servicio de Cirugía del Hospital Naval de Viña del Mar / Reoperations in femoral and inguinal hernias: bilaterality and relapse. Surgery Service in the Navy Hospital Viña del Mar

Introducción: En nuestro país la hernioplastia inguinocrural es una de las intervenciones quirúrgicas más frecuentes, pero hay escasos estudios acerca de los resultados a largo plazo. Materiales y método: Estudio observacional de cohorte retrospectiva utilizando base de datos, fichas clínicas y electrónicas, con el objeto de analizar las causas de reintervenciones en hernioplastias inguinocrurales desde el año 2000 hasta el 2010, con seguimiento hasta junio del 2015. Resultados y discusión: Se realizaron 1.765 intervenciones con los códigos de hernia inguinal y femoral, de los cuales 100 casos requirieron reintervención: 84 hombres y 16 mujeres, con edad promedio de 62 años para la primera cirugía. En un tercio se encontró HTA, y en el 38% de los hombres uropatía obstructiva, sin ser estadísticamente significativo (p = 0,6). Se demostró intervención por hernia contralateral en el 38% de los casos, con aparición predominante dentro de los 3 primeros años desde la primera cirugía; en el 37% se demostró recidiva herniaria. Los pacientes que recidivaron equivalen al 2,7% del total de cirugías realizadas, pero al considerar las recidivas solo con técnica de Lichtenstein, esta fue del 1,7% con respecto al total de hernioplastias realizadas, presentándose dentro de los 3 primeros años. En 5 casos se demostró doble recidiva y en 2 casos triple recidiva. Cinco pacientes presentaron complicaciones: 2 hematomas, un seroma, una inguinodinia crónica y un paciente falleció por obstrucción intestinal postoperatoria. Conclusión: Nuestros resultados son similares a casuísticas nacionales y metaanálisis reportados en cuanto a tipo de pacientes, comorbilidades asociadas y porcentaje de recidiva a largo plazo, con menor tasa de complicaciones.

Introduction: In our country, hernioplasty for inguinocrural hernia is one of the most frequent surgical procedures, but there are scanty studies bring over of the long-term results. Materials and method: Observational retrospective cohort study, using clinical data base of patient's clinical history, in order to analyze the cause of reoperations on our inguinocrural hernioplasty data base, from the year 2000 to the year 2010, and with a follow up until June 2015. Results and discussion: In total they were performed 1,765 interventions coded crural and inguinal hernia, 100 cases required reoperation, 84 men and 16 women with an average age of 62 years for the first surgery. In a third hypertension was found, and in 38% of men, obstructive uropathy, not statistically significant (P=.6). Reoperation for contralateral hernia was performed in 38% of the cases, with predominant appearance within the first three years after the first surgery; in 37% of the cases, hernia recurrence was demonstrated. Patients, who recurred, were equivalent to 2.7% of all surgeries performed, but considering Lichtenstein technique, it was only 1.7% of all hernioplasties, occurring within the first three years. In 5 cases, we found double recurrence, and triple recurrence in two. Five patients had complications: two bruising, seroma, chronic inguinal pain and one death by postoperative intestinal obstruction. Conclusion: Our results were similar to those reported in our country in relation to the type of patients, comorbidities and recurrence at long-term, but with a lower rate of complications.

Incarcerated femoral cystocele – A rare case report.

Femoral hernia accounts for about 3-5% of all groin hernias. Incarceration and strangulation are more common with femoral hernia. Femoral hernia with bladder as content and its incarceration is reported very rarely in literature. Our patient is a 48 year old multiparous female who presented with left sided groin swelling with difficulty in micturition and was diagnosed to have incarcerated femoral cystocele.

Diez años de experiencia empleando la técnica con plug de Lichtenstein en la hernia femoral / Femoral Hernia. Ten years of experience in using the Lichtenstein Plug Technique

Introducción: se han desarrollado diversas técnicas para la reparación de la hernia femoral. La técnica con el Plug de Lichtenstein desde el año 1989 ha permitido obtener un menor índice de complicaciones y recidivas, así como una recuperación temprana de las actividades habituales del paciente. Su aplicación, ampliamente difundida en la cirugía electiva, también puede realizarse en la cirugía de urgencia. El objetivo de este trabajo es valorar la experiencia de nuestro grupo básico de trabajo en el tratamiento quirúrgico de la hernia femoral mediante la aplicación de esta técnica. Métodos: se realizó un estudio observacional descriptivo con carácter retrospectivo en nuestro grupo básico de trabajo, del servicio de cirugía del Hospital General Docente Enrique Cabrera entre los años 2001 al 2010, a un conjunto de pacientes a los cuales se les aplicó la técnica del Plug de Lichtenstein para la reparación de la hernia femoral. Se estudiaron las variantes anatómicas de las hernias así como las complicaciones posoperatorias y la evolución clínica. Resultados: la edad media de los pacientes fue de 58,7 años (19-92 años) y el sexo femenino fue el de mayor incidencia (78 por ciento), además la localización más frecuente, la derecha (67,5 por ciento). La prótesis empleada en la hernioplastia fue la de polipropileno. Se aplicó la anestesia local a 29 pacientes (63 por ciento). El tiempo quirúrgico medio fue de 25 minutos (15-65 minutos). La deambulación fue precoz y la estancia media hospitalaria fue menos de 24 horas, en la mayoría de los pacientes. Solo se constató una infección de la herida y una recidiva herniaria en un paciente. Conclusiones: la técnica del Plug de Lichtenstein debe considerarse entre las de elección en el tratamiento de la hernia femoral(AU)

Introduction: many technical procedures have been developed to repair femoral hernia. Since 1989, the Lichtenstein Plug technique has allowed lower rates of post operative complications and recurrence as well an earlier recovery of the daily life activities of the patients. This technique, widely known in elective surgery, can also be performed in the emergency surgery. Objective: to assess the experience of our basic working team in the surgical treatment of the femoral hernia through this technique. Methods: a retrospective, descriptive and observational study was conducted by our basic working team from the surgery service at Dr. Enrique Cabrera General Teaching Hospital from 2001 to 2010, which covered the patients who underwent surgical repair of femoral hernia through the Lichtenstein Plug technique. The anatomical variants of the hernias as well as the postoperative complications and the clinical progress were studied. Results: the mean age of the patients were 58.7 years old, (19-92 years), with prevalence of females (78 percent). The most frequent location of hernias was on the right (67.5 percent). Polypropylene reticular mesh was the most commonly used. Local anaesthesia was applied in 29 patients (63 percent), and the mean surgical time was 25 minutes (15-65 minutes). The average length of stay at hospital was less than 24 hours. Just one patient developed wound sepsis and herniary recurrence. Conclusions: the Lichtenstein Plug procedure should be regarded as a choice in treating femoral hernia(AU)

Totally Extraperitoneal (TEP) Approach for Femoral Hernia

PURPOSE: The aims of this study were to evaluate the efficacy of laparoscopic totally extraperitoneal (TEP) repair of femoral hernia. METHODS: Eight patients who underwent laparoscopic TEP repair for femoral hernia between 2008 and 2010 were reviewed retrospectively. In total, 256 adult patients underwent inguinal or femoral hernia repair; TEP was performed in 224 patients. The preoperative diagnosis, clinical symptom, operative finding, postoperative complications, chronic pain, and recurrence were analyzed. RESULTS: The incidence of femoral hernia was 8 (3.1%) in the present study. The female to male ratio was 3:1 (6 females and 2 males). Seven patients were preoperatively misdiagnosed with inguinal hernia using ultrasonography. Computed tomography (CT) was performed in three patients, and femoral hernia was diagnosed in two patients. Two patients had synchronous femoral hernia with direct or indirect inguinal hernia. One patient has previously undergone ipsilateral inguinal hernia repair. In all patients, the hernia sac was irreducible by gas insufflation. Seven patients had lipoma-like soft tissue in hernia sac. Peritoneal tears developed in three patients. There was one postoperative complication: chronic discomfort due to seroma. There was no recurrence during median 6.5 months (range 2~26). CONCLUSION: Laparoscopic TEP repair is safe and effective therapeutic option for repair of femoral hernia. CT images are the most valuable type for the evaluation of the femoral hernia.

Saphena Varix Mimicking Femoral Hernia

Saphena varix is very rare disease that characterized by isolated distention of the saphenous vein below the sapheno-femoral junction. Saphena varix must be differentiated from other medical problems that can cause a groin mass. A 49-year-old man presented with a palpable mass on the right upper thigh and he'd had the mass for 6 months. There was no history of trauma, and the mass was especially noticeable when he was standing. On the physical examination, a 5 cm-sized soft, nontender, compressible mass was detected at the right upper medial thigh near the femoral foramen. Doppler sonography showed a saccular venous dilatation of the great saphenous vein just below the saphenofemoral junction. On computed tomography, there were superficially dilated veins in the right thigh and calf, a focal saccular aneurysm at the proximal segment of the right greater saphenous vein and no evidence of deep vein thrombosis. Aneurymal excision and stripping of the greater saphenous vein were performed. No complication was observed at the 2 week follow-up.

The Diagnostic Concordance of Femoral Hernia and the Factors Influencing Diagnosis

PURPOSE: Misdiagnosis is frequent in femoral hernia as inguinal hernia. The aims of this study were to examine the diagnostic concordance and to define the factors having influence on the correct diagnosis of femoral hernia. METHODS: Thirty-two patients who underwent femoral hernia operations were analyzed retrospectively. RESULTS: The mean age of the study subjects was 65.8+/-15.5 (36~97) and the female to male ratio was 5.4:1. The mean body mass index (BMI) was 19.8 kg/m2 (14.6~26.9 kg/m2). Twelve patients (37.5%) showed pre- and post-operative diagnostic concordance and 20 patients (62.5%) did not. Among the 20 misdiagnosed cases, 16 cases were misdiagnosed as inguinal hernia, 2 cases as lipoma, and 1 case as lymphadenopathy. The factors related to the correct diagnosis of femoral hernias were associated with groin mass (96.9%, 31/32: 23 painless and 8 painful), size fluctuation of mass (cyclic wax and wane pattern) (84.4%, 27/32), long duration of mass (over 1 month) (75.0%, 24/32), femoral venous compression CT findings (63.6%, 14/22), and positive ultrasonographic findings (42.1%, 8/19). Emergency operation was done in 12 cases (37.5%). Incarceration was found in 23 cases (71.9%) and most of the incarcerated organs were omental fat (11 cases) and small bowel (10 cases). Bowel resection was done in 4 cases and 2 patients combined inguinal hernia. CONCLUSION: Through the careful taking of medical history and physical examination, physicians can achieve the correct diagnosis and can also decrease the frequency of emergency operations and their related complications.

Clinical Analysis of Femoral Hernia in Adult

PURPOSE: Compared with other types of hernia, femoral hernias in adults are less common and we have had little literature about femoral hernia. The purpose of this study was to evaluate the incidence of femoral hernias in adults and to analyze the characteristics of femoral hernias. METHODS: This retrospective study was based on the medical records of 60 patients who underwent herniorrhaphies for treating femoral hernia in adults from January 2001 to December 2007. We analyzed the incidence of femora hernias, the symptoms, the operative techniques, the complications, the mortality and the postoperative recurrence rates. RESULTS: The incidence of femoral hernia was 4.6% in all cases of inguinal hernias. The incidence in females was about 4 times higher than in males (P<0.001). The most common symptom was bulging. The operative technique was changed from plug technique to bilayer technique. Seroma including swelling and pain were prominent complications. We experienced one case of mortality. CONCLUSION: Femoral hernia is a rare type of inguinal hernia in adult. Femoral hernia is more frequent in females and in the aged; it is an important surgical pathology with high rate of incarceration or strangulation. In consideration of the pathology of hernia and difficulty of the peri-operative diagnosis, the Prolene Hernia System herniorrhaphy is a superior method to other methods in femoral hernia.

Inguino-Femoral Hernia in Women

PURPOSE: Inguino-femoral hernias in women are less common than that in a man, and we have had limited experience for hernia repair in women. The purpose of this study was to evaluate the characteristics of inguino-femoral hernias in females and to establish the choice of specific treatment for inguino-femoral hernia in females. METHODS: This retrospective study was based on the medical records of 566 patients who underwent 657 cases of herniorrhaphies for treating inguino-femoral hernia in adult females from January 1998 to June 2006. We evaluated the incidence of hernia, the operative technique and the length of the operation, the complications and the postoperative recurrence rate. The operative findings and median time to reoperation for a recurrent hernia were also evaluated. RESULTS: During the 8.5-year period, we performed 2,931 herniorrhaphies in 2,274 patients. Of these, 657 herniorrhaphies were done in females (22.4%). The types of hernia in females were indirect inguinal hernia (67.3%), direct inguinal hernia (10.2%), the pantaloon type (10%) and femoral hernia (14.9%). Femoral hernia was more frequent in females (14.9%) compared to males (3.5%) (P<0.001). The overall rate of reoperation due to incarceration in the females was higher (2.5%) than that in the men (1.1%)(P<0.001). Femoral hernias in females was found at reoperation in 39.7% compared with 17.2% in the males (P<0.001). CONCLUSION: The incidence of inguino-femoral hernia in females was higher than the results of most published studies and the reoperation rate was higher in females. The increased frequency of femoral hernia at reoperation in females suggests avoiding injuries to the posterior wall of the inguinal canal and the need for exploration of the femoral canal at the time of the primary operation.

Incarcerated Femoral Hernia Including a Gangrenous Appendix

Femoral hernias account for up to 4% of all hernias that occur in the inguinal region. The hernial sac usually contains the greater omentum, small intestine, large intestine and preperitoneal fat, but rarely, in only 0.8% of the all cases, it also contains the appendix. Femoral, inguinal and incisional hernias, combined with appendicitis, occur in only 0.13% of cases. Thus, the incidence of appendicitis associated with a femoral hernia would be expected to be very rare. Herein, a case of an incarcerated femoral hernia, including a gangrenous appendix, is reported. An 81-year-old female was admitted with a protruding mass in the right inguinal area of 2 days duration. On inspection, a 4x3 cm sized erythematous bulging mass was noted. On palpation, the mass was tender and fixed in nature. There were no signs of peritoneal irritation or other palpable masses in the whole abdomen. Under the impression of a femoral hernia, a manual reduction was attempted, but to no avail. An immotile edematous intestine was noted on ultrasonography, and fluid retention with decreased blood circulation was noted in the intestine, suggestive of incarceration. An emergency operation was performed, with an incision made through the right groin region, where an incarcerated femoral hernia, including a gangrenous appendix, was found. An appendectomy and McVay repair were performed. The patient was discharged after 5 days, without any complications.

The Importance of Femoral Hernia in Children

Femoral hernias are very uncommon in children and very easily misdiagnosed. During a period of three years, three children of femoral hernia were treated by one pediatric surgeon at Severance Hospital. Only one case was diagnosed correctly before surgery; the other two were thought to be either an indirect inguinal hernia or groin mass. Only one patient had curative hernioplasty (McVay hernioplasty) at the first operation; the other two did not have curative hernioplasty at the first operation. 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 possible femoral hernia.