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Paik, Park, and Son: Totally Extraperitoneal (TEP) Approach for Femoral Hernia
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2010; 79(5): 393-398.

Published online: 12 November 2010

DOI: https://doi.org/10.4174/jkss.2010.79.5.393

Totally Extraperitoneal (TEP) Approach for Femoral Hernia

Jin Hee Paik, M.D., Yong Lai Park, M.D., Byung Ho Son, M.D.

Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Corresponding author (byunghomd.son@samsung.com)

Received 15 April 2010       Accepted 9 August 2010

Copyright © 2010 The Korean Surgical Society

Abstract

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.

Keywords: Computed tomography, Femoral hernia, Laparoscopic surgery, Totally extraperitoneal (TEP) repair

Figures and Tables

Fig. 1
(A) The schematic drawing of relevant anatomy of right femoral hernia.(1) (B) Laparoscpic view of right groin area.
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Fig. 2
The ultrasonographic finding of right femoral hernia. The Doppler image shows the femoral hernial sac nearby the femoral vessel.
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Fig. 3
The CT finding of left femoral hernia. There are typical findings of femoral hernia: venous compression and localized hernial sac in femoral area (arrow).
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Fig. 4
Laparoscopic view of right femoral hernia. The lipoma-like mass observed in femoral area defect.
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Table 1
Clinical characteristics of patients
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*Sono = ultrasonography; †CT = computed tomography; ‡Tb = tuberculosis.

Table 2
Operative findings
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*CH = coexisting hernia; †RAGI = reduction after gas insufflations; ‡HC = hernia content (associated lipoma like lesion); §ATAAW = adhesion to anterior abdominal wall; ∥PTDR = peritoneal tearing during reduction and its treatment; TMD = taking mesh down the Cooper's ligament.

Table 3
Clinical outcomes of laparoscopic TEP* repair for femoral hernia
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*TEP = totally extraperitoneal.

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