it is the one most likely to strangulate ( 4 ) , its repair must often be accompanied by examination of , and sometimes resection of , bowel or omentum ( 4 ) . the low skin - crease approach of lockwood allows easy access to the hernial orifice , but a separate laparotomy incision is required if any of the abdominal contents are to be resected or examined . lotheissen ( 1878 ) described the high approach through the posterior wall of the inguinal canal ; its disadvantage is the increased incidence of subsequent direct inguinal hernia through the disrupted posterior wall . mcevedy s ( 6 ) approach through the rectus sheath ( 1950 ) with a vertical para - rectus skin incision avoids this disadvantage and offers good exposure of the femoral canal and abdominal contents . a modification using a skin crease incision instead of a vertical one was proposed by mouzas / diggory ( 2 ) ( 1956 ) . many patients with femoral hernia in whom strangulation ( 6,8 ) is suspected are elderly and infirm . a single incision is to be preferred , especially as it can be performed under local anaesthetic ( 2 ) with minimum disruption and disadvantage . an oblique skin incision of about 6  8 cms is made from the hernial bulge itself to a point midway between pubic symphysis and umbilicus ( figure 1 ) . the anterior rectus sheath is incised at right angles to the skin incision from pubic symphysis extending if necessary into the external oblique ( figure 2 ) . the rectus muscle is retracted towards the midline ; it is sometimes necessary to divide the inferior epigastric vessels . the tranversalis fascia is incised and the neck of the sac exposed by finger dissection . the lacunar ligament is divided ( with care because of the presence of an abnormal obturator artery at its cresenteric margin in 10% ) . at this stage the sac is opened and the potentially infected collection therein is drained before the peritoneal cavity is opened . the hernia is then reduced and the neck of the sac is excised . a general inspection of the peritoneal cavity is carried out and any resection performed , if needed . the femoral canal is repaired from inside by approximating the inguinal ligament to the pectineal ligament with interrupted non - absorbable sutures . care should be taken to avoid damage to the femoral vein ( repair of the right femoral canal is best done standing from the left side of the patient , but repair of the left femoral canal is best done standing from the left side ) . the rectus sheath is closed with absorbable sutures , and the skin closed with sub - cuticular absorbable sutures . all patients should have a urinary catheter in - situ during the operation and routine dvt prophylaxis . thirty - five femoral hernias with suspected strangulation were repaired by this method . in ten , bowel resection was necessary ; local anaesthesia was used in nine of these . in the other twenty - five thorough examination showed the bowel to be viable . all the wounds have healed well apart from two in which infection developed ; these responded to antibiotics . all patients were followed up for two years and neither recurrence nor incisional hernia occurred . this approach can be used in all cases in which strangulation ( 4 ) is suspected , as both hernia repair and bowel resection can be done through the same incision . the incision can be converted into a midline laparotomy by extending it proximally in the midline ( figure 3 ) . the femoral canal is better repaired from inside and hence the chance of recurrence is greatly reduced . the chance of incisional hernia developing is greatly reduced as the skin incision and rectus sheath incision are at right angles reinforcing each other . this operation is suitable for local anaesthesia ( 2 ) even if resection of the bowel is needed , an advantage as many patients are elderly , infirm and unfit for general anaesthetic .
several methods of femoral hernia repair have been described . 
 it is the one most likely to strangulate , its repair must often be accompanied by examination of , and sometimes resection of , bowel or omentum . 
 we describe a new method to repair such a hernia .