Comments on “unsuspected femoral hernia in patients with a preoperative diagnosis of recurrent inguinal hernia”

Excerpt

Femoral hernias, big or small, are the ultimate challenge in hernia surgery. They are relatively uncommon, often overlooked and have traditionally been poorly managed. To surgeons, rookies and veterans alike, they symbolize the baptism of fire. More than for many other surgical problems, they demand an exquisite knowledge of a complex and delicate anatomy. They also demand a close look and analysis of all that is written about them to avoid confusion. Therefore …

Small femoral hernias may be difficult to diagnose by physical examination and are sometimes identified unexpectedly by laparoscopy.

There is no doubt that the same statement applies to any well-executed approach, laparoscopic or open. Notable exceptions are the onlay mesh techniques and various gadgets since no attempt is made to look at femoral rings from the preperitoneal space.

Laparoscopy sometimes reveals a hernia … frequency of unsuspected contralateral inguinal hernias is estimated to (sic) 11–28 % in patients planned for unilateral laparoscopic hernia repair …

“Unsuspected femoral hernia” appears as a leitmotif throughout, but it is never clear whether the aim of the paper is to look at ipsilateral unsuspected (occult, hidden, concealed) hernias only. The author(s) do obtain a preoperative consent for exploration of the opposite side, in case “a contralateral hernia was clearly visual (sic) without preperitoneal dissection”! …