Perioperative management - Femoral hernia repair – TIPP technique

  1. Indication

    • All operable femoral hernias; indication relative in patients with impaired operability
    • Emergency surgery in incarcerated femoral hernia
  2. Contraindications

    • Generally inoperable patients
    • Local inoperability, e.g., due to: abdominal wall infection, tumor, aneurysm
  3. Preoperative diagnostic work-up

    Preoperative diagnostic work-up


    • General risk factors

    • Underlying disorders of abdominal cavity (e.g., peritoneal carcinosis)

    • Particular complaints, particular physical strain (e.g., sports)

    • Infected inguinal region

    • Previous inguinal surgery (recurrent hernia)


    • General physical examination ascertaining operability

    • Special abdominal examination

    • Special examination of inguinal region

    • Assessment of skin and soft tissue condition

    • Possibly ultrasound study of abdominal wall / cavity

    • Possibly classification of hernia (e.g., for scientific purposes)

    Differential diagnosis

    • Other masses: Lymphadenitis, lipoma, varicose nodules, tumors, etc.

    • Other causes of pain: Groin strain, adductor tendinopathy, nerve irritation etc.

  4. Special preparation

    • Mark the side of the hernia
    • Single-shot administration of 2nd generation cephalosporin before local anesthesia or induction of general anesthesia 
  5. Informed consent

    General risks


    • Bleeding

    • Injury, e.g., to nerves, vessels, bowel, bladder


    •Secondary bleeding, hematoma

    • Seroma

    • Thrombosis and embolism

    • Intestinal passage (atony, ileus)

    • Secondary healing

    • Infection and abscess

    Special risks

    •Chronic pain

    • Foreign body reaction

    • Mesh migration

    • Mesh infection

    • Mesh rupture

    • Recurrent hernia


General anesthesiaLaryngeal mask airwaySpinal anesthesiaLocal anesthetics in inguinal hernia repair

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