Having dissected the fascia from the femoral sac, the boundaries of the femoral canal should be identified circumferentially around it. Starting medially, usually it is possible to identify the lacunar ligament passing inferomedially from the inguinal ligament. Similarly, the inguinal ligament is identifiable with ease superiorly. Careful sharp dissection is used to tease the sac away from each landmark.
Then, the sac is elevated to reveal the pectineal fascia overlying pectineus. Finally, the most difficult boundary is encountered - the lateral side. Here, the femoral vein is usually indistinct due to the fascia of the femoral sheath. Meticulous dissection is carried out keeping to the wall of the sac until all of the circumference is identifiable and free.
If the boundaries of the hernial neck are not clearly identified, there is a risk that sac excision will be distal to the point of strangulation.
Last reviewed 01/2018