<prompt> Neck of the sac of femoral hernia liesAbove and medial to pubic tubercleBelow and lateral to pubic tubercleAt saphenous openingAt the level of inguinal ligament  <response>: Ans. b Below and lateral to pubic tubercle Ref. Bailey and Love 25lhpg. 971.FEMORAL HERNIA A femoral hernia occurs through the femoral canal that is bounded superiorly by the iliopubic tract, inferiorly by Coopers ligament, laterally by the femoral vein, and medially by the junction of the iliopubic tract and Coopers ligament lacunar ligament. A femoral hernia produces a mass or bulge below the inguinal ligament. Femoral hernias are difficult to diagnose clinically because of their deep location in the femoral canal.- Laugiers is through the gap in the lacunar Gimbemats ligament.- Naraths occurs only in patients with CDH and is due to lateral displacement of psoas muscle. Account for 1 of all abdominal wall hernia Female: male ratio is 4:1 Commonest in middle-aged and elderly women, more common in parous Rare in children Much less common than inguinal hernias but are as common as inguinal hernias in older women They always remain below the inguinal ligament and lateral to the pebic tubercle and are more prone to incarceration and strangulation than inguinal hernias. This type of hernia occurs more commonly in females and usually contains preperitoneal fat, omentum, andor small bowel. Clinically, saphena varix is its closest DD.Femoral hernia : Protrudes below inguinal ligament through femoral canal below and lateral to pubic tubercle.More common in women.Direct inguinal hernia: Protrudes through the internal Hesselbachs triangle. Bulges directly through abdominal wall medial to inferior epigastric artery. Goes through the external superficial inguinal ring only. Covered by transversalis fascia. Usually in older men.Indirect inguinal hernia: Goes through the INternal deep inguinal ring, external superficial inguinal ring, and Into the scrotum. Enters internal inguinal ring lateral to inferior epigastric artery. Occur in Infants owing to failure of processus vaginalis to close. Much more common in males.Management: All uncomplicated femoral hernias should be repaired as an urgent elective procedure- A femoral hernia can be repaired using: The standard Coopers ligament repair, A preperitoneal approach, or A laparoscopic approach. Three classical approaches to the femoral canal have been described:- Low Lockwood.- Transinguinal Lotheissen- High McEvedy Irrespective of approach used the following will be achieved:- Dissection of the sac- Reductioninspection of the contents- Ligation of the sac- Approximation of the inguinal and pectineal ligaments 