correct answer
d Open muscle repair
Femoral hernias are rare in children, with an incidence < 1% of all pediatric groin hernias. Because of the rarity, they are often not recognized until the time of surgery and surgeons may not be as familiar with the optimal repair in these patients. The defect can be seen medial and inferior to the iliopubic tract.
As the laparoscopic high ligation for indirect hernias in children has gained popularity, some have discussed using similar techniques for femoral hernias. However, femoral hernias are a muscle defect and simple sac ligation will likely recur. Therefore, the best repair is a tissue repair, typically an approximation of Cooper’s Ligament and the inguinal ligament to narrow the femoral canal without impinging on the femoral vein. This is typically performed with an open low-groin incision. Placing the Maryland dissector into the defect and palpating it under the skin can allow for a focused incision. Mesh is not advised in a young child.
Many recommend prepping the umbilicus into the field with a planned open indirect hernia repair, since a negative exploration for an indirect hernia in a child may (rarely) miss a femoral hernia, and insertion of a laparoscope in this setting can make the diagnosis.
