A surgeon plans an operation for a strangulated femoral hernia requiring possible bowel resection. Which operative approach provides the best access to both the femoral canal and the peritoneal cavity for resection?

• A Low (Lockwood) crural approach
• B Transverse suprapubic subcutaneous approach
• C Inguinal subcuticular approach
• D High (McEvedy) extraperitoneal approach via a lower paramedian or oblique incision ✓

Explanation

The McEvedy high approach uses a lower midline, paramedian, or oblique incision and enters the preperitoneal plane, exposing the femoral ring from above. It gives full control of the sac, permits division of the lacunar ligament safely, and, critically, allows conversion to laparotomy for assessment and resection of non-viable bowel. The Lockwood low crural approach offers poor access for bowel resection, and releasing a tight neck from below risks cutting a gangrenous loop.

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

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Written and medically reviewed by the StethoPrep medical team.