A 55-year-old woman presents with a femoral hernia. The femoral canal boundaries are: medially the lacunar ligament, laterally the femoral vein, anteriorly the inguinal ligament, and posteriorly the pectineal (Cooper's) ligament. In the Lockwood (low) approach to femoral hernia repair, which layer is incised first?

• A External oblique aponeurosis
• B Transversalis fascia
• C Cribriform fascia over the fossa ovalis ✓
• D Lacunar ligament

Explanation

The Lockwood (low, crural) approach to femoral hernia repair is made through an incision directly over the hernia below the inguinal ligament. The cribriform fascia covering the fossa ovalis (the opening in the deep fascia through which the femoral hernia descends) is the first layer incised to expose the hernial sac. This approach is suitable for small uncomplicated femoral hernias. The McEvedy (high) approach enters through a paramedian incision. The Lotheissen approach traverses the inguinal canal and transversalis fascia to access the femoral canal from above.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.