Perioperative management - Femoral hernia repair – TIPP technique

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

• Generally inoperable patients
• Local inoperability, e.g., due to: abdominal wall infection, tumor, aneurysm

History

• 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)

Examination

• 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.

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

General risks

Intraoperative:

• Bleeding

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

Postoperative:

•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