Right Recurrent Femoral Hernia with Left Inguinal Hernia - A Case Report

Femoral hernias are a relatively uncommon type, accounting for only 3% of all hernias. While femoral hernias can occur in both males and females, they occur approximately 10 times as frequently in women than in men because of the wider bone structure of the female pelvis³. Femoral hernias develop in the upper part of the thigh near the groin just below the inguinal ligament, where abdominal contents pass through a naturally occurring weakness called the femoral canal. Femoral hernia have the highest rate of incarceration amongst groin hernia, 5%–20%⁵

P126 LAPAROSCOPIC TREATMENT OF HYDROCELE IN FEMORAL CANAL: A CASE REPORT

Aim The hydrocele of the femoral canal (Femorocele) is one of the rarest entities of femoral hernia (1). All of the reported cases were an intraoperative diagnosis and were treated with an open approach. We are reporting, the probably first femorocele diagnosed and treated laparoscopically. Material and Methods A 57-years-old female patient was presented in our outpatient clinic with pain and an unclear lump in the groin area for 6 months. The sonographic examination revealed a cystic structure in the groin area resampling Nuck’s cyst. An elective laparoscopic exploration and transabdominal preperitoneal (TAPP) repair was planned. Results A laparoscopic exploration was carried out. Intraoperatively, the cystic structure was not found in the Nuck’s Canal, but in the femoral canal as a content of a femoral hernia with some pre-peritoneal fat. By the extraction of the cyst, a gush of clear fluid was noted. After the usual preparation of the preperitoneal area, a mesh was placed in TAPP technique. Conclusions This rare variety of femoral hernias, femorocele, is commonly misdiagnosed as a strangulated hernia or Nuck’s cyst (as in this case) among other differential diagnoses (2). All published femorocele cases were treated with an open approach. As demonstrated here, such unclear cases can be laparoscopically explored and treated accordingly.

Surgical Sponge Retained in Femoral Canal for 22 Years: A Case Report

Background: Retained surgical items (RSIs) are not very common in the orthopedic surgery. Here, we are reporting a case of a sponge pad left in the femoral canal for 22 years. We could not find any other reported case of retained surgical sponge in the femoral canal and that is what makes this case report unique. Case Report: The patient was a 42 year-old man who underwent surgery for the fixation of a fractured femur 22 years ago. On August 2020, this patient was seen complaining about pain at the surgical site. The assessments revealed a sponge pad retained in the femoral canal, which was removed by surgery. The union of fractured bone did not take place in the first surgery, so after 6 months a second surgery was performed and the dynamic compression plate (DCP) placed was successfully replaced with an intramedullary nail. Conclusion: The surgeon could not detect the pad 22 years ago and the patient had no significant symptom all this time. The most important take-away lesson of this paper is that retention of surgical pads could also occur with correct gauze counting, so detection and prevention protocols for RSIs must be taken seriously.

Clinical Evaluation of Abdominal Wall Hernias

Hernia is defined as protrusion of a viscus or part of a viscus through a weakening or defect in the wall of its containing cavity. Areas of potential anatomical weakness includes inguinal canal, femoral canal, linea alba, umbilical scar, as well as acquired surgical trauma. The weakening/defect may be acquired (like surgical scar) or congenital (like deep inguinal ring). Raised intraabdominal pressure is the most important factor that leads to the development of hernia through the weak areas. Clinically, the hernia usually presents with an abdominal swelling that progresses gradually over time. The sites of hernia are characteristic and usually points towards the diagnosis. While evaluating a hernia clinically, it is important to identify the content of the hernia sac and whether it suffers any complication, as well as the cause of the hernia development. Failing to identify these prior to surgery, will likely result in morbidity as well as recurrence. This chapter will focus on the clinical art of history taking and examination of different abdominal hernias.

Bilateral Cemented Custom-Made Total Hip Arthroplasty in Paget's Disease with Femoral Cortical Thickening and Canal Narrowing

In this report, we present a case of a 57-year-old man complaining of pain in both his hips. Clinically, the patient reported lameness and reduction in the range of motion of the hips. Radiographic imaging showed a very narrow medullary femoral canal, confirmed by a computed tomography scan. In consideration of the narrowness of the femoral canal and cortex thickening, and due to the rarity of the clinical case, we opted to use a custom-made prosthesis. We performed total hip arthroplasty, initially on the right side. One year later, we repeated the procedure on the left side. One year after the last surgery, the patient reported well-being and continuous improvement in walking, with no complications. This case report highlights the features and the critical issues related to this kind of surgery in patients affected by Paget's disease of the bone and the importance of custom-made implants in challenging cases.

551 The Relationship Between Canal Diameter and the DORR Classification - Presented by Dr John Vincent and Dr Ryan Doherty of NIMDTA, formerly Queen's University Belfast

Background Particularly in broach-only uncemented total hip arthroplasty, a narrow femoral canal presents a technical challenge. Traditionally such femurs have been considered to be Dorr A. To our knowledge, however, no study has reported on the relationship between isthmus width and the Dorr classification. Method We reviewed 500 high-quality, hard copy radiographs. Dorr classification and isthmus canal width were measured using an electronic caliper by 5 independent observers with intraobserver and interobserver error calculated. For this study, we defined a narrow canal as being 10 mm at its narrowest point (isthmus). Results Eight percent (40) were Dorr A, 85% (424) Dorr B, and 7% (36) Dorr C. With respect to isthmus width for Dorr A, 63% (25) were 10 mm compared to just 13% (55) of Dorr B. However, overall because there were more Dorr B femurs, 69% of those with an isthmus of 10 mm were Dorr B. Conclusions In this population, almost 70% of patients with an isthmus 10 mm were Dorr B, with only 30% being Dorr A. When using a broach-only technique, isthmus width should be routinely measured on the preoperative anteroposterior radiographs so as to alert the surgeon to potential problems.

Possibilities of instrumental diagnostic methods for visualizing the pubic periosteum in the femoral canal

Performing classical methods of plasty in patients with femoral hernia is possible if Cooper's ligament – the pubic periosteum – is preserved. Patients with a long history of femoral hernia develop thinning and atrophy of the pubic periosteum. The aim of the study was to establish the possibilities of instrumental research methods to determine the preservation or atrophy of the pubic periosteum in patients with femoral hernia. It was found that using the X-ray method and CT before the operation, it was not possible to establish the preservation or atrophy of the pubic periosteum in the area of the femoral canal. With ultrasound, it is possible to visualize the pubic periosteum in young patients.

Options for the treatment of the femoral hernia with atrophy of the public bone in the formed femoral canal

Femoral hernias make up 2–4 % of the total number of patients with hernias [1], the results of their treatment do not tend to improve [2–6].The aim of the study was to establish the incidence of atrophy of the pubic periosteum in patients with femoral hernia and to analyze the possible methods of surgery in their treatment.Material and methods. The analysis of the treatment of 249 patients with femoral hernias for the period from 1996 to 2021 was carried out. There were 61 men (24.5%), women – 188 (75.5%). in 14 (5.6%), atrophy of the pubic periosteum was revealed during operations. Since 2009, patients with femoral hernia and atrophy of the pubic periosteum began to use the "Method for the treatment of inguinal and femoral hernias" (patent for invention No. 2445002, authors V.I. Belokonev, A.V. Vavilov, A.V. Zharov, Yu. V. Ponomareva, A.G. Nogoga) [11], which was performed by inguinal access.Conclusions. In 5.6% of patients with femoral hernia and a long history, under the influence of the hernial sac, atrophy of the pubic periosteum occurs.A method of treating femoral and inguinal hernias by closing the hernial orifice with an elastic mesh with a protrusion at the medial edge of the mesh corresponding to the distance from the medial edge of the pupar ligament at the level of the femoral vein to the lower edge of the superior horizontal branch of the pubic bone (patent for invention No. 2445002) is an effective method of treating patients with hernias with destruction of the pubic bone periosteum in the femoral canal.