Management of recurrent and perivascular femoral hernias by giant prosthetic reinforcement of the visceral sac.

Abstract

Classical hernioplasties have been used to manage primary femoral hernias for over a century. In women, infrainguinal repair of the parietal defect is simple and successful. In men, femoral hernias are frequently associated with inguinal hernias and, therefore, a Cooper's ligament repair is indicated. For recurrent femoral hernias, however, the classical hernioplasties are often inadequate just as they are for the repair of recurrent inguinal hernias and a prosthetic repair is indicated. Giant prosthetic reinforcement of the visceral sac (GPRVS) is the descriptive name of a properitoneal groin hernioplasty with a large piece of Mersilene. The repair focuses on retaining the peritoneum rather than repairing the parietal defect and is efficient, anatomic, sutureless, and tension-free. It is the only repair that reliably eliminates all hernias of the groin, including perivascular femoral hernias. In this study, GPRVS by way of an abdominal incision was used to treat recurrent and perivascular femoral hernias. Also included are a description of and experiences with a new technique of unilateral GPRVS performed through an infrainguinal approach. The data reveal no recurrences in 69 problem femoral hernias of which 15 were primary (two perivascular) and 54 recurrent (four perivascular). Giant prosthetic reinforcement of the visceral sac performed transabdominally or by way of the newly described infrainguinal method is a useful and reliable method to treat primary, recurrent and perivascular femoral hernias.