Femoral hernias occur in the groin – the small area of the lower abdomen on each side, just above the line separating the abdomen and the legs.Femoralherniasoccurinthegroin–thesmallareaofthelowerabdomenoneachside,justabovethelineseparatingtheabdomenandthelegs.Theyarerelativelyuncommon(theyaccountfor2%ofallherniasand6%ofallgroinhernias,theother94%areinguinal),morelikelyto occurinwomen thaninmen(70%offemoralherniasoccurinwomen,probablybecauseoftheirwiderpelvismakingthefemoralcanalslightlylarger) andareoftenconfusedwithinguinal herniasbybothpatientsanddoctors.Almosthalfofallfemoralherniasfirstcometolightasemergencies.WhatwouldIsee?Asmallswellingverylowdownnexttothegroinskincrease;sometimesjustbelowthecreasesotheswellingseemstobeatthetopofthethigh.WhatwouldIfeel?Oftenverylittle,perhapsabitofanache.Thisiswhytheytendtobeso‘dangerous’–thereareoftennosymptomsuntiltheystrangulate.Ifstrangulationoccursthelumpbecomeshardandtender.Afemoralherniathatgetsstuckor‘incarcerated’,onthewaytostrangulation,cancauseseverelocalandabdominalpain,nauseaandvomiting.Ifalooporknuckleofintestineiswithintheherniasacitrequiresimmediate,emergencysurgery.Theestimatedtimeforbowelviability(survival)isabout8-12hours.Whyisstrangulationcommon?Thereasonsomanyfemoralherniascometolightasemergenciesisprobablythatthefemoralcanal,throughwhichtheherniaappears,isnarrowwithmostofitsentrance(thefemoralring)rigidandunyielding.WhatshouldIdo?Femoralherniasshouldberepairedearlyandnotleftuntiltheybecomeaproblem.Notalldoctorsrealisehowimportantthisis.Whatoperation?Thegoalofsurgeryistocloseoffthefemoralcanal.Beforemesharrivedonthescenethiswasdonewithstitches,stitchingthefrontandbackoftheopeningtogether.Theproblemisthatthereisnotmuch‘give’here,tryingtosewtworigidstructurestoeachother.Theresultcanbebothpainfulandnotveryreliable.Ourpreferredmethodistoplaceasoftmeshconepluginthefemoralcanal.Thissitsinthefemoralcanalwhereitremains,stoppinganythinggoingthrough.Thiscanbedonewithlocalanaesthesiathroughashortcosmetically-placedin