The Femoral Hernia: Some Necessary Additions

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.