Question 6#
The technique indicated for femoral hernias in cases where prosthetic material is contraindicated is:
A. The Bassini repairB. The Shouldice repair
C. The McVay repair
D. Lichtenstein tension-free repair
Correct Answer is C
Comment:
The McVay repair addresses both inguinal and femoral ring defects. This technique is indicated for femoral hernias and in cases where the use of prosthetic material is contraindicated (Fig. below). Once the spermatic cord has been isolated, an incision in the transversalis fascia permits entry into the preperitoneal space. The upper flap is mobilized by gentle blunt dissection of underlying tissue. Cooper ligament is bluntly dissected to expose its surface. A 2- to 4-cm relaxing incision is made in the anterior rectus sheath vertically from the pubic tubercle. This incision is essential to reduce tension on the repair; however, it may result in increased postoperative pain and higher risk of ventral abdominal herniation. Using either interrupted or continuous suture, the superior transversalis flap is then fastened to Cooper ligament, and the repair is continued laterally along Cooper ligament to occlude the femoral ring. Lateral to the femoral ring, a transition stitch is placed, affixing the transversalis fascia to the inguinal ligament. The transversalis is then sutured to the inguinal ligament laterally to the internal ring.
McVay Cooper ligament repair.