Femoral Hernia
Everything in the library about femoral hernia — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
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In-Depth Reviews
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Inguinal Hernia With M. Rosen
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An interactive discussion about inguinal hernia between Jeffrey Ponsky, MD and Michael Rosen, MD. Dr. Rosen is professor of surgery at Cleveland Clinic Lerner
podcast31:05 · Jul 2026
Inguinal Hernia With M. Rosen
Listen →
An interactive discussion about inguinal hernia between Jeffrey Ponsky, MD and Michael Rosen, MD. Dr. Rosen is professor of surgery at Cleveland Clinic Lerner
podcast31:05 · Jul 2026
Inguinal Hernia With M. Rosen
Listen →
An interactive discussion about inguinal hernia between Jeffrey Ponsky, MD and Michael Rosen, MD. Dr. Rosen is professor of surgery at Cleveland Clinic Lerner College of Medicine. Table of Contents 1:00:44 1 Introductions 2:02:45Work up for
podcast31:05 · Jul 2026
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Inguinal Hernia With M. Rosen
In the Fitzgibbons VA study of minimally symptomatic to asymptomatic hernias in patients in their 70s-80s, the risk of presenting with an emergency problem (incarceration/strangulation) requiring operation was less than 1% (actually one-third of 1%) over the initial study period.
host_summaryMichael Rosen3:22 ↗
In the Fitzgibbons study, almost one-third of observed patients developed symptoms requiring operation within two years, and by five years almost three-quarters developed symptoms.
host_summaryMichael Rosen4:00 ↗
Patients who developed symptoms during observation in the Fitzgibbons study did not do any worse with their eventual operation compared to immediate repair.
host_summaryMichael Rosen4:20 ↗
For an 89-year-old with asymptomatic hernia, observation is appropriate because odds are in a couple years they might not develop symptoms, but in younger patients the odds are against them living the rest of their life without symptoms.
opinionMichael Rosen4:40 ↗
Inguinal hernias can be repaired under local anesthesia in high-risk patients with severe comorbidities (cardiac disease, ascites, coagulopathy).
clinicalMichael Rosen6:32 ↗
The learning curve for laparoscopic inguinal hernia repair is real, with some studies showing 200-250 cases required.
host_summaryMichael Rosen9:00 ↗
The primary advantage of laparoscopic repair is placing mesh away from nerves, resulting in lower risk of chronic pain compared to open repair when done correctly.
clinicalMichael Rosen9:20 ↗
Chronic pain incidence in open inguinal hernia repair varies depending on measurement method: very high if detailed surveys are used, lower if only counting patients who present with complaints.
epidemiologicalMichael Rosen9:50 ↗
Laparoscopic repair offers approximately one week to 10 days earlier recovery compared to open repair.
clinicalMichael Rosen12:10 ↗
The disadvantage of laparoscopic repair is operating near intestines with risk of intestinal injury and major blood vessel injury, though this risk should be incredibly low with proper technique.
clinicalMichael Rosen12:25 ↗
In elderly patients or those on anticoagulation requiring quick restart, open repair is preferred to avoid dissecting the retroperitoneal space.
opinionMichael Rosen13:20 ↗
In a 78-year-old with symptomatic hernia on one side and asymptomatic hernia discovered laparoscopically on the other side, repairing the asymptomatic side doubles anesthetic time and increases hematoma risk without clear benefit.
opinionMichael Rosen14:26 ↗
Previous lower abdominal surgery increases risk of enterotomy and OR time for laparoscopic repair; if patient has not had previous open inguinal hernia, open approach is preferred.
opinionMichael Rosen16:26 ↗
Previous prostate surgery creates unpredictable difficulty for laparoscopic repair, ranging from straightforward to brutal; currently managed with open repair.
opinionMichael Rosen16:55 ↗
The most important part of laparoscopic repair is parietalization of the cord (stripping peritoneum off cord inferiorly and posteriorly), a principle promoted by Rene Stoppa in open preperitoneal repairs.
clinicalMichael Rosen17:58 ↗
The inferior dissection is the Achilles heel of laparoscopic repair because it is awkward to view, risky for creating peritoneal holes, and close to vessels.
clinicalMichael Rosen18:40 ↗
Inadequate inferior peritoneal dissection leads to use of smaller mesh, but Stoppa's original description for unilateral inguinal hernia specified never using less than 15×15 cm (6×6 inch) mesh, which is larger than most laparoscopic meshes being placed.
host_summaryMichael Rosen19:05 ↗
For large direct hernias, heavier weight mesh material should be used.
opinionMichael Rosen20:30 ↗
Heavyweight mesh is approximately 90 grams per meter squared (Marlex or Prolene), midweight is 40-50 grams per meter squared, and lightweight (Ultrapro) is less than 30 grams per meter squared.
clinicalMichael Rosen21:02 ↗
Lightweight mesh has less foreign body and may contract less due to better ingrowth, but has half the material and is at risk for fracturing, particularly in direct hernias where it bridges and muscles never come together.
clinicalMichael Rosen21:50 ↗
Heavier weight mesh rarely breaks but can cause chronic pain if wrinkles or buckles are present in the groin.
clinicalMichael Rosen22:30 ↗
Surgeons commonly downsize preformed meshes; for inguinal hernia repair, never use smaller than a large preformed mesh to cover the entire myopectineal orifice.
opinionMichael Rosen23:00 ↗
If struggling with mesh placement during laparoscopic repair, the problem is inadequate dissection of the space, not oversized mesh; the solution is to remove mesh and dissect more widely.
clinicalMichael Rosen23:24 ↗
There is no evidence that absorbable fixation causes reduction in pain, provides better fixation, or improves long-term outcomes compared to permanent fixation.
clinicalMichael Rosen24:09 ↗
If absorbable tack is placed through a nerve, it is the neuroma that causes the problem, not the tack itself.
clinicalMichael Rosen24:20 ↗
There is mounting evidence that medium-weight polypropylene mesh can be placed in contaminated fields, with several series in ventral hernias supporting this.
host_summaryMichael Rosen24:56 ↗
Bassini or McVay tissue repairs remain appropriate operations for contaminated fields.
opinionMichael Rosen25:10 ↗
For incarcerated femoral hernia with bowel compromise, an infrainguinal vertical incision allows direct access to the hernia sac, bowel resection if needed, and reduction without dividing the inguinal ligament.
clinicalMichael Rosen25:55 ↗
To facilitate reduction of incarcerated femoral hernia contents, the lacunar ligament (medial to femoral space) can be released with scissors or bovie to gain an extra centimeter, avoiding destruction of the inguinal ligament.
clinicalMichael Rosen26:35 ↗
Reverse McVay repair for femoral hernia involves taking the inferior border of the inguinal ligament and sewing it down to Cooper's ligament from below, starting immediately lateral to the femoral vein to avoid impingement.
clinicalMichael Rosen27:20 ↗
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