Strangulation found during repair
Ideally, during the initial assessment of a patient with a femoral hernia, strangulation will be suspected from the history and examination. If this is the case, either of two approaches may be taken to provide adequate access to the sac:
- extra-peritoneal approach
- transperitoneal approach
However, strangulation is sometimes found only during low or high approaches, in the absence of convincing clinical features. Evidence for strangulation includes sero-sanguinous fluid within the sac and black bowel seen through the peritoneum.
There are three management possibilities:
- extraperitoneal approach
- transperitoneal approach
- continue with high or low approach
One salient rule is that no non-viable viscus should be returned to the abdominal cavity.
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