TITLE:
The Femoral Hernia: Some Necessary Additions
AUTHORS:
Ljubomir S. Kovachev
KEYWORDS:
Femoral Hernia, Femoral Canal, Transversalis Fascia, Groin Anatomy
JOURNAL NAME:
International Journal of Clinical Medicine,
Vol.5 No.13,
July
15,
2014
ABSTRACT:
Purpose: The anatomic region through which most inguinal hernias emerge
is overcrowded by various anatomical structures with intricate relationships.
This is reflected by the wide range of anatomic interpretations. Material and Methods:
A prospective anatomic study of over 100 fresh cadavers and 47 patients
operated on for femoral hernias. Results: It was found that the transversalis
fascia did not continue distally into the lymphatic lacuna. Medially this
fascia did not reach the lacunar ligament, but was rather positioned above it
forming laterally the vascular sheath. Here the fascia participates in the
formation of a fossa, which varies in width and depth—the preperitoneal femoral fossa. The results did not confirm the
presence of a femoral canal. The distances were measured between the pubic
tubercle and the medial margin of the femoral vein, and between the inguinal
and the Cooper’s ligaments. The results clearly indicate that in women with
femoral hernias these distances are much larger. Along the course of femoral
hernia exploration we established the presence of three zones that are rigid
and narrow. These are the potential sites for femoral hernia incarceration. Conclusion:
In the lower infra-inguinal space, where femoral hernias could appear, the
integrity is achieved by means of a complex fusion of fascio-ligamentous
structures, where the iliopubic tract, the medial condensations of the
transversalis fascia and the lacunar ligament are the most important.