Open femoral hernia repair: one skin incision for all

We propose a technique for open femoral hernia repair that involves a single skin incision 1 cm above the medial half of the inguinal ligament that allows all of the above approaches to the hernia sac depending on the operative findings. Thus the repair of simple femoral hernias can be performed from below the inguinal ligament. If found, inguinal hernias can be repaired. More importantly, resection of compromised bowel can be achieved by accessing the peritoneal cavity with division of the linea semilunaris 4 cm above the inguinal ligament. This avoids compromise of the inguinal canal, and with medial retraction of the rectus abdominis muscle enables access to the peritoneal cavity and compromised bowel.This simple technique minimises the preoperative debate as to which incision will allow the best approach to the femoral hernia sac, allow for alteration to a simple inguinal hernia repair if necessary, and more importantly obviate the need for further skin incisions if compromised bowel is encountered that requires resection.Femoral hernias are relatively uncommon, making up 2-8% of all adult groin hernias[1,2]. Incarcerated femoral hernias, however, are the most common incarcerated abdominal hernia[3], with strangulation of a viscus carrying up to 14% mortality[4]. Femoral hernias are a common cause of small bowel obstruction and remain the most frequent cause of strangulation in this setting, necessitating immediate operative intervention[5].Classically three approaches are described to open femoral hernia repair: Lockwood's infra-inguinal approach, Lotheissen's trans-inguinal approach and McEvedy's high approach.The infra-inguinal approach is the preferred method for elective repair, approaching the femoral canal from below through an oblique incision 1 cm below and parallel to the inguinal ligament. This approach however offers little scope for resecting any compromised bowel.The trans-inguinal approach involves a skin incision 2 cm above the inguinal ligament,