c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Strangulated Femoral Hernia, McVay Repair: 7

A D V E R T I S E M E N T

   
 

The perforated segment was resected and primary anastomosis performed. The sac was inverted and ligated at the level of the proximal end of the femoral canal. The abdomen was copiously irrigated and the midline incision closed.       

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Strangulated Femoral Hernia, McVay Repair: 8

A D V E R T I S E M E N T

   
 

Because of the size of the defect, it was elected to do a formal hernia repair. Because of the contamination, a McVay repair was performed to avoid using mesh. External oblique was divided, round ligament was encircled with a Penrose drain and retracted cephalad, and the transversalis fascia was opened exposing Cooperís ligament. The view is from the patientís head, iliac vein is labeled.      

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Strangulated Femoral Hernia, McVay Repair: 9

A D V E R T I S E M E N T

   
 

A relaxing incision was made in the deep layers of the anterior rectus sheath (see anterior inguinal hernia repair  and McVay hernia repair) to allow the falx to reach Cooperís ligament without tension. The medial sutures approximate falx to Cooper's. The transition stitch bridges from Cooper's to edge of the femoral defect (transversalis fascia) to iliopubic tract and inguinal ligament, tightening the femoral ring. The wound was closed in layers.    

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This page was last modified on 7/10/2007.