After excision of the femoral hernia, it is vital to repair the canal. This is achieved by apposition of the pectineal and inguinal ligaments using a figure-of-eight stitch. A 3/0 prolene or nylon stitch is used. The key problem of siting the suture is that if too lateral, it will compress the femoral vein with obstruction of venous flow. If too medial, there will be a tendency to hernial recurrence in the space medial to the vein. It is wise to displace the vein laterally with a retractor to find the most suitable position to place the stitch. Tightening of the stitch apposes the inguinal ligament to the pectineal line.
Some authorities advocate reinforcement of the repair using a patch of pectineus fascia that is raised from the muscle on three sides but still attached on its superior margin. It is folded back superiorly over the site of the repair and sutured into place with a continuous non-absorbable stitch such as prolene.
The subcutaneous tissue may be closed with interrupted absorbable stitches to close any dead space. Skin closure is a matter of personal preference; some authors prefer tape over suture to reduce the infective risk.
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