Femoral hernia surgery method.

Hernia Discussion Forums Hernia Discussion Femoral hernia surgery method.

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    • #31643
      Monika
      Participant

      Hi everyone,
      Dose anyone on here know if you can have surgery on femoral hernia with Desarda , Shouldice or Bassini method ? Dose it work like on inguinal hernia?
      Would really appreciate any info with this .

    • #31649
      MarkT
      Participant

      Shouldice method is used to repair femoral hernias and the Shouldice Hospital has done many thousands of them. They note on their site that mesh may be used for these repairs though, depending upon the nature of the defect, tissue quality, etc.

    • #31650
      Monika
      Participant

      Hi Mark T,
      Thank you so much for the info. I just contacted Dr Kang as well . How long did you wait for response from their hospital?

    • #31651
      drkang
      Participant

      Hi Monika,
      I am sorry to hear you have multiple hernias.

      Shouldice or Desarda or Bassini methods for inguinal hernia repair cannot be used to repair a femoral hernia. I don’t know if Shoudice hospital has a special tissue repair method for a femoral hernia.

      Among the well-known tissue repair methods, the one that can be used for femoral hernia is McVay repair, but its surgical method is rather difficult, so I think it will be very difficult for doctors who are not familiar with tissue repair these days to perform this operation successfully.

      Our hospital has developed and implemented a new and simple tissue repair method for a femoral hernia. Femoral hernia is not common, so we don’t have many cases. Over the past 7 years, about 80 cases of femoral hernia have been operated on with this tissue repair method. And there was one recurrence so far.

    • #31652
      MarkT
      Participant

      You should hear back rather quickly if you email them, probably before the end of the following day.

      I think you are overseas? They have an int’l toll-free # as well. They might ask you to create an account on the website and submit their medical questionnaire to get detailed info.

    • #31653
      Monika
      Participant

      Thank you so much for your information Dr Kang . Do you think tissue repair is a good choice for famoral hernia?

      @ Mark T , thanks again for being so very helpful ! Having 4 hernias it’s actually super scary at the moment I truly don’t know why as I am 39 year old very slim non smoker non drinker women , and I just don’t understand how this is actually happening . I have also read that famoral hernias are uncommon. I am worried that there has to be something wrong with my collagen production . How long did it take you to organise the trip to Dr Kang ? I am not fully vaccinated just had one dose after which I developed myocarditis. Do you know if not fully vaccinated ppl are allowed in the South Korea ? I had Covid as well in February .

    • #31654
      Monika
      Participant

      Dr Kang , could you please tell me how do you perform the famoral repair with your method? Is it a tension repair?

    • #31656
      MarkT
      Participant

      A tissue repair for femoral hernias was developed at Shouldice and it is described in this paper:

      Shouldice, E. B. (2003). The Shouldice repair for groin hernias. Surgical Clinics of North America 83(5), 1163-87. https://doi.org/10.1016/S0039-6109(03)00121-X

      I pulled a copy of the article, since the abstract does not give much info. This paper is almost 20 years old and I have no idea what (if anything) may have changed. Also, per the Shouldice website, they do use mesh in some cases. After a lengthy description of their inguinal repair, this is what is written about their femoral repair:

      “Although initially mesh was used to try to decrease the recurrence rates, in 1984 Dr. Alexander, of our institution, introduced a pure tissue repair that is now one of the methods used for correction of femoral hernias when the inguinal ligament is intact. This repair, called the complete groin repair, also includes an inguinal exploration and repair of any other defect identified at that time.

      Complete groin repair technique for femoral hernia

      Dissection is performed in the same manner as for all groin hernias, including division of the transversalis fascia to allow a clear view of Cooper’s ligament. Reduction of the herniated mass is facilitated by complete exposure and splitting of the posterior wall of the canal and dissection below the inguinal ligament, freeing the hernia. A sac is not always present in femoral hernias; fat alone is identified in 7.3% of our male patients and 4.4% of our female patients with primary femoral hernias. Once the femoral orifice is cleared of the hernial mass, permanent interrupted sutures (Fig. 10) are passed initially through the defect from below and through Cooper’s ligament then carried anteriorly and superficially through the inguinal ligament and iliopubic tract in wide loops. These sutures are placed about one centimeter apart closing off the defect and covering the area from the pubic tubercle to the femoral vein. These are left untied but clamped together with hemostats, with the free ends extending inferiorly toward the thigh. The repair then proceeds as with an inguinal hernia repair. The second line of suture, however, interlocks with the previously placed interrupted sutures across the femoral defect. Upon completion of the third and fourth lines of the Shouldice repair, the interrupted sutures are drawn up and tied, thus pulling the Shouldice repair toward Cooper’s ligament. Sometimes, to avoid tension the tissues may not be completely opposed; however, in these situations the sutures appear to act in a similar manner to a mesh repair closure of the defect.”

      Again, I have no idea if this remains the way they do the repair or if it has been modified since this was written. I would certainly contact Shouldice with any questions.

      Monika, I went to Shouldice for inguinal repairs (30yrs for one side, 17yrs for the other). Both seem to have been flawless…no issues since then. I believe Mike M and Pinto both had inguinal repairs performed recently by Dr. Kang and they speak highly of their experiences as well.

      • #31659
        drkang
        Participant

        Hi Monika,

        After infrainguinal skin incision, find and treat hernia sac, and simple closure of hernia defect with non-absorbable 3-0 Prolene. It is performed under sedative local anesthesia, and the skin incision is about 4 cm, and the operation time is usually about 15 minutes.

        Sorry.
        This is a reply to Monika’s question.

        • This reply was modified 4 months ago by drkang.
    • #31657
      Monika
      Participant

      Hi Mike T , thank you for this very detailed information . I am actually overwhelmed how everyone on here is so helpful .I’ll will definitely contact Shouldice hospital. I am worried as from what I have been reading famoral hernias are complicated and have higher risk of complications during and after operation . On top of that it’s an uncommon hernia so unfortunately there is not many specialists.

    • #31658
      drkang
      Participant

      Thank you, Mark T.

      Thanks to you, I become to know how to operate on a femoral hernia in Shouldice hospital.

      The reason that McVay repair, which is a representative tissue repair method for femoral hernia, is not an easy operation for the average surgeon, is that it requires suture to the Cooper’s ligament. Because the Cooper’s ligament is deeper than the inguinal ligament and is very close to the femoral artery and vein, it is very careful to access the Cooper’s ligament during surgery.

      However, the femoral hernia repair method in Shouldice hospital seems to deal with the Cooper’s ligament more difficult than McVay repair in my opinion. Of course, Shouldice surgeons are likely to have a lot of experience in this operation, so I think that this operation could be performed more easily there.

      • #31661
        Monika
        Participant

        Dr Kang ,
        I understand you don’t perform McVay technique as it’s more complicated and carries more risk to the artery and vain. Could you please write how do you perform the femoral hernia procedure to minimise any recurrence as well? Also do you perform abdominal wall strengthening technique to treat all the hernia rings so that an inguinal hernia dose not occur postoperatively? Do you look for any occult hernias during the operation?

      • #31663
        MarkT
        Participant

        Hi Dr. Kang,

        I am happy to provide info when I find it…of course, I am not a surgeon and do not understand all of the details, so your response is very valuable for learning more 🙂

        Your comments also reinforce the idea that the skill and experience of the surgeon may be the most important variables for patients to consider, especially with complex tissue repairs. The relatively low complication, recurrence, and pain rates that your patients (and Shouldice Hospital patients) enjoy is almost certainly due in large part to those factors.

    • #31668
      drkang
      Participant

      Hi Monika,

      McVay or Shouldice method for a femoral hernia takes a transinguinal approach. Therefore, to repair the loose femoral canal through which the femoral hernia passes, the external oblique aponeurosis is opened, the spermatic cord is mobilized, and the transversalis fascia is opened before repairing a defect. This process is complex and thus may reduce the surgical success rate.

      In our infrainguinal approach, after skin incision, the defect can be identified easily by finding the hernia sac and dissecting it from the surrounding subcutaneous fat tissue. In order to prevent recurrence in this operation, the most important thing is to separate the weak tissues around the defect, that is, the hernia opening, and to check the strong ligamentous structure. If this strong defect margin is accurately sewn and blocked, the operation is completed easily.
      Usually, the diameter of femoral hernia defect is less than 1 cm, so there is not much tension after surgery.

    • #31669
      Monika
      Participant

      Hi Dr Kang ,
      Thank you for explaining that to me . I am considering coming to South Korea very soon for the operation. Do you perform any exploratory ultrasounds before the operation to rule out any other potential missed hernias (occult hernias ). I have one left femoral hernia that is 7mm and an inguinal hernia on my right side 6mm that doesn’t bother me at all . However I am worried that there might be other potential hernia.
      Would appreciate your feedback .

    • #31670
      drkang
      Participant

      Yes.
      We do an ultrasound of both groin areas to confirm the presence of all possible hernias before surgery.

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