title: Laparoscopic-assisted repair of femoral hernias in children.
abstract: BACKGROUND
  Femoral hernias in children are rare, difficult to diagnose, and require a different treatment approach than the standard indirect inguinal hernia repair. Most femoral hernias in children are still repaired by using a conventional McVay technique.
  
  
  OBJECTIVE
  We have developed a simple, effective laparoscopic-assisted femoral hernia repair that avoids opening the inguinal canal in children.
  
  
  METHODS
  A 5-mm trocar is placed in the umbilicus, and the femoral hernia is visualized intracorporeally via a 30-degree laparoscope. The laparoscope is then passed into the hernia sac, with the visual axis pointing anterior toward the skin. Guided by transillumination, a 1-cm skin incision is made over the hernia sac at the upper thigh; the hernia sac is identified and dissected free from surrounding tissue. The sac is then grasped within the abdomen, inverted, twisted, and an endoscopic tie is placed at its neck. The defect between the medial pectineal and inguinal ligaments is closed externally with an absorbable suture.
  
  
  RESULTS
  The described technique was successfully used on 3 boys, each with right femoral hernias (age 4-11; mean = 7). On 6-month follow-up, all patients had excellent cosmetic results with minimal scars and no recurrence.
  
  
  CONCLUSIONS
  Laparoscopic-assisted femoral hernia repair is straightforward, efficient, and avoids dissection of the inguinal canal, thereby circumventing any risk of injury to the vas deferens and spermatic vessels. Although these early results are encouraging, more patients and longer follow-up are necessary to substantiate our technique.
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Alabama, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
authors.forename: Obinna O
authors.initials: OO
authors.lastname: Adibe
authors.forename: Erik N
authors.initials: EN
authors.lastname: Hansen
authors.forename: Frederico G
authors.initials: FG
authors.lastname: Seifarth
authors.forename: Cathy A
authors.initials: CA
authors.lastname: Burnweit
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Muensterer
mesh_terms: D002648:Child; D002675:Child, Preschool; D004210:Dissection; D006550:Hernia, Femoral / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male