Plate 217

All femoral hernias should be repaired unless contraindicated by the patient's condition.

The preoperative preparation is directed by the patient's general condition. When the contents of the hernia sac are strangulated, the fluid and electrolyte balance is restored by Ringer's lactate solution administered intravenously. Antibiotics are instituted if the examination indicates the possibility of nonviability of the bowel and consequent necessity for resection of intestine. Sufficient time is taken to fully resuscitate the patient. Constant gastric suction is instituted. A slowing of the pulse and a good output of urine are signs favorable to early surgical intervention. Uncomplicated femoral hernias may be repaired as ambulatory surgical procedures.

(See Plate 207.)

The patient is placed in a supine position with the knees slightly flexed to lessen the tension in the groin. The entire table is tilted slightly with the patient's head down.

The skin is prepared in the routine manner. A sterile transparent plastic drape may be used to cover the operative area.

The surgeon should have in mind the relationship of the hernia sac to the deep femoral vessels and Poupart's ligament (Figure 1). The usual incision for inguinal hernia is made just above Poupart's ligament in the line of skin cleavage (Figure 2). The incision above Poupart's ligament is preferred because it gives the best exposure of the neck of the sac and provides better exposure if bowel resection and anastomosis are necessary. The incision is made and carried down to the external oblique fascia. After the fascia has been dissected free of the subcutaneous fat, retractors are inserted in the wound. The external oblique fascia is divided in the direction of its fibers, as in the incision for inguinal hernia (Plate 207). The round ligament or spermatic cord is retracted upward along with ...