It is important that the surgeon understand the regional anatomy of the femoral space. This opening is approximately 1 to 1½ cm in diameter and lies directly lateral to the pubic tubercle but inferior to the inguinal ligament (figure 1). The fascia overlying the pectineus muscle forms the posterior wall, whereas the lateral aspect is bounded by the slightly compressible femoral vein as it emerges under the inguinal ligament. Clinically, the femoral herniation presents as a mass that may be confused with superficial inguinal lymphadenopathy. In thin patients, the line of the inguinal ligament from the anterior superior spine to the pubic tubercle can be projected and the femoral herniation will clearly present below this, being immediately lateral to the pubic tubercle and medial to the pulsation of the femoral vessels. If the surgeon is certain of this diagnosis, which may be aided by the use of ultrasonography, then the lower limited oblique incision directly over the mass may be made (figure 2b). If the diagnosis is in doubt, the patient is obese, or the possibility of strangulation exists, then the upper incision (figure 2a) is made so as to provide maximum exposure and flexibility. This incision is slightly lower than that made for the usual inguinal hernia. It is above and parallel in general to the inguinal ligament with a more transverse medial extension. The incision is made and carried down to the external oblique fascia. The fascia over the canal is cleaned so as to expose the external ring. The external oblique fascia is divided in the direction of its fibers in the manner used for exposure in inguinal hernias. A pair of hemostats are placed on the superior and inferior leaves of the external oblique, which is then cleaned by blunt dissection down to the internal oblique muscle superiorly and the shelving edge of the inguinal ligament inferiorly. The round ligament or spermatic cord with attached ilioinguinal nerve is dissected free and retracted superiorly either with a rubber Penrose drain or a Richardson retractor (figure 3). The transversalis fascia constituting the floor of the canal is explored to rule out any direct herniation, and thereafter the region of the internal ring is explored to rule out the presence of an indirect herniation.