The transperitoneal approach to a femoral hernia is used when there is a large or long-standing sac with or without stranglated contents that cannot be successfully dealt with by an alternative approach. It is less elegant than the extra-peritoneal approach but it is more simple to execute and reliable.
The sac is approached through the peritoneal cavity via a lower paramedian approach. The aponeurosis is divided on the side of the hernia and rectus abdominis is retracted medially. The peritoneum is elevated and entered ensuring that no vital structures lie beneath the incision. The inguinal vessels are located anteroinferiorly; the neck of the sac should lie medially. The contents of the sac are reduced and inspected. Any non-viable tissue is removed. The sac is transfixed and ligated from within.
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