Editing Femoral hernia (section)

=== '''Lockwood approach''' ===

* Incision inferior and parallel to inguinal ligament, immediately on top of the hernia
** Can also use something like this approach through a normal IHR incision, then follow the EO down over the top of inguinal ligament and into femoral canal
* Dissect sac free from overlying tissue, isolating its neck
* Inspect sac and open if indicated (be careful of bladder as medial wall, if there's a sliding hernia)
** Transfix and ligate if opening, then allow to retract
* Reduce
** If incarcerated, relaxing incision may be made superiorly through inguinal ligament (tag ends with suture beforehand, so they can be repaired afterwards) or posteriorly into pectineal ligament
** Best not to incise laterally (femoral vein) or medially (aberrant obturator artery, which you wouldn't be able to see from below). Won't make much space by incising posteriorly.
* Close ring with primary repair (or mesh plug if larger). Sutures between inguinal ligament and pectineal ligament.