Femoral hernia.

About 20 years ago one of us was so impressed by seeing a number of direct inguinal herniae following the Lotheissen (I898) repair of a femoral hernia that he decided to try the low or Lockwood type of repair. The low operation has been used almost exclusively since that time in over 500 cases. At that time and probably at the present time the Lotheissen operation is the most popular, because it is considered to give better access to ,the neck of the sac, easier resection of gut should this be necessary, increased safety of a possible aberrant obturator artery if Gimbernat's ligament is divided in the presence of strangulation and finally it was considered that suture of the conjoint tendon to Cooper's ligament should produce fewer recurrences than suturing Poupart's ligament to the pectineal fascia. In spite of these apparent very weighty arguments we believe the inguinal canal should only be opened if there is an associated inguinal hernia because the transversalis fascia has to be incised in order to expose the femoral sac from the inguinal canal.