Point Of Strangulation

As a femoral hernia descends it may be strangulated on the sharp edge of Gimbernat's ligament or at the upper portion of the falciform process (Fig. 404).

Division Of Stricture

If Gimbernat's ligament is the constricting band the incision is to be made in an upward and inward direction. If the upper portion of the falciform process is the constricting part the incision should be made directly upward into Poupart's ligament.

In order to avoid wounding an anomalous obturator artery which may wind around the neck of the sac, the stricture is best cut from without inward.

Radical Cure Of Femoral Hernia

The intestine and omentum having been replaced, the neck of the sac is ligated as high up as possible and cut away or, preferably, the two ends of the ligature are brought up through the aponeurosis of the external oblique and tied on its surface just above Poupart's ligament. To close the femoral canal two or three sutures are inserted as follows: If the hernia is on the right side, the needle is passed downward through the inner end of Poupart's ligament, close to the spine of the pubis, into the pectineal or pubic portion of the fascia lata, and brought out alongside of the femoral vein. It is then inserted again through the edge of the falciform process and the suture tied, thus pulling the falciform process and the lower edge of Poupart's ligament down on the fascia covering the pectineal muscle. Two or three sutures are all that are required. Another way of inserting the sutures is longitudinally, instead of transversely. The first would be close in to Gimbernat's ligament, the second a little farther out, and the third as close to the femoral vein as possible (Fig. 406).

Fig. 406.   Operation for the radical cure of femoral hernia.

Fig. 406. - Operation for the radical cure of femoral hernia.