[size=20px]A ten-year-old girl presents to the emergency department with bilious emesis and groin pain six hours prior to arrival. She is mildly distended with a visible mass in the right inguinal region. The mass cannot be reduced. At laparoscopy the right internal ring appears closed. However, an inferomedial defect is identified consistent with a femoral hernia. The recommended operative repair for this child is?

 

A Inversion of the hernia sac with closure of the external oblique aponeurosis

 

B Placement of preperitoneal mesh

 

C High ligation of the hernia sac

 

D Approximation of the transversalis fascia to Cooper’s ligament

 

E Approximating the transversalis fascia to the inguinal ligament with closure of the external oblique​[/size]

D the answer

c

correct answer

D Approximation of the transversalis fascia to Cooper’s ligament

 

Inguinal hernia repair is a common pediatric surgical procedure. However, diagnosis of femoral hernia in the pediatric population remains challenging. Overall, this clinical entity remains rare, accounting for 1-2% of pediatric groin hernias depending on series. There is a slightly higher incidence in the laparoscopic era presumably from easier identification at time of laparoscopy. Most children who present are misdiagnosed with an inguinal hernia and treated operatively with high ligation. During exploration, the femoral hernia may not be identified, with children subsequently representing as a recurrent inguinal hernia before identification of the femoral defect. Due to the rarity of this disease entity there are no large studies reviewing the optimal operative approach. However, regardless of laparoscopic or open repair, most authors agree with a Cooper’s ligament repair as described by McVay.​

D