1 Clinical data 1.1 General data 24 patients, 23 female and 1 male, aged 41-63 years, mean age 52.5 years, all did not occur embedded, strangulated; 1.2 Anesthesia 8 cases applied continuous epidural anesthesia, 16 cases performed surgery under local anesthesia; 1.3 Surgical steps 1.3.1 1 1.5 cm above the midpoint of the inguinal ligament to the pubic symphysis, make an incision 4 cm to 1.3.2 The transversus abdominis fascia was incised medially in the inferior abdominal wall artery to reveal the neck of the hernia sac, which is medial to the trap ligament and lateral to the femoral vein, and the hernia sac was sharply plus bluntly freed from the femoral canal and further freed to the neck of the hernia sac without high ligation; 1.3.3 The hernia sac was pushed into the abdominal cavity, and then the 1.3.3 Push the hernia sac into the abdominal cavity, then fill the polypropylene mesh plug into the hernia ring (note: not filled in the femoral ring), fix it with 6 to 8 stitches with the medial transverse abdominal fascia, pubic comb ligament and lateral edge of the trap ligament, so that the polypropylene mesh plug does not protrude outward by increasing abdominal pressure; 1.3.4 Repair the transverse abdominal fascia as much as possible, and if it is more complete, place the mesh plug completely behind the transverse abdominal fascia; 1.3.5 If the transverse abdominal fascia is found to be weak or defective, place the flat piece in the posterior to the round ligament of the uterus or the spermatic cord, lay flat and properly sutured around to fix it, the lower end needs to exceed the pubic tuberosity; 1.3.6 The round ligament of the uterus or the spermatic cord is put back in place, and the tendon membrane of the external oblique abdominal muscle is intermittently sutured, layer by layer, to the skin, after the operation. Postoperatively, a 500g sandbag was used to compress the area for 6-8h. 2 Results 2.1 Operative time Unilateral femoral hernia takes about 30min, the shortest 20min, and those with large hernia sacs that are difficult to be dragged out from the femoral canal require incision of the inguinal ligament to enlarge the femoral ring are slightly longer, generally taking 40min to 50min; 2.2 Recovery Most patients got out of bed and relieved themselves of urine in 3-6h, 5 cases were injected with non-anesthetic Most of the patients had fever not exceeding 38℃ within 24h-48h. All patients were discharged from the hospital within 3 days without any anti-infective drugs, and the stitches were removed in 7 days in the outpatient clinic. All patients in this group were Ⅰ/nail healed; 2.3 Follow-up 2 cases were followed for 4 years, 5 cases for 3 years, 9 cases for 2 years, 6 cases for 1 year, and 2 cases for less than 1 year, all patients had no recurrence, and 9 patients complained of feeling local hard lumps within 3-5 months, which gradually softened and disappeared after 6 months. 3.1 Design concept 3.1 The purpose of femoral hernia repair surgery is to block the channel of internal organs falling down to the femoral canal. The requirements of modern hernia surgery are light pain after repair surgery, short recovery time, low recurrence rate, and few complications; prevention of hernia formation at the inguinal floor under the area of the repaired primary hernia. Tension-free hernia repair is superior to any other surgical procedure. Based on these principles, we designed a modified McVay’s tension-free repair of femoral hernia. The concept of this procedure is to have a clear understanding of the internal orifice of the femoral hernia, i.e., where the neck of the femoral hernia sac is located. We believe that the femoral ring and the femoral canal are only the descending channels of the femoral hernia, and that the true neck of the hernia sac is located above the femoral ring, which consists of the lateral transversus abdominis fissure, the superior united tendon arch, the medial trap ligament, and the inferior iliopsoas bundle, and that repair here is consistent with the principles of both high and preperitoneal repair. It is inappropriate, because such repair not only fails to achieve the purpose of repairing the abdominal wall, but also may cause compression of the femoral vein in the femoral canal and cause deep vein thrombosis in the lower extremity. 3.2 Choice of anesthesia The choice of anesthesia should be differentiated according to the specific situation. Local infiltration anesthesia has little effect on the patient’s physiological state, and the patient recovers quickly after surgery; it basically does not affect the patient’s postoperative bed urination, so if possible, local anesthesia should be preferred. In contrast, epidural anesthesia has complete pain blockage and relatively mild peritoneal traction response when lifting the hernia sac; separation to the hernia sac neck is not difficult. Specifically, local infiltration anesthesia is indicated for the following conditions: thin body shape; first-time surgery; old age, general condition, especially poor cardiopulmonary function; non-emergency surgery. And epidural anesthesia is suitable for: those with recurrence, heavy adhesions and difficult separation after hernia surgery; those who are too obese and expect poor local anesthetic effect. 3.3 Surgical precautions (1) The femoral ring, iliopubic bundle, pubic comb ligament and trap ligament must be fully exposed so that the polypropylene mesh plug can be accurately placed to completely block the channel for the viscus to fall down into the femoral canal. (2) When fixing the polypropylene mesh plug to the outer edges of the pubic comb ligament and the trap ligament, the sutures should be continuous or finely interrupted, taking care not to leave gaps as much as possible to prevent recurrence. (3) The hernia sac must be peeled off to reach the neck of the hernia sac, which is essential for accurate placement of the polypropylene mesh plug and proper suturing. (4) Although the use of flat slices was not recommended in the literature in the past, we placed them in consideration of the congenital weakness of the inguinal canal and the possibility of inguinal hernia formation in the future. 3.4 Advantages and indications of the procedure The tension-free repair of femoral hernia reported in the literature currently uses polypropylene mesh plugs to fill the femoral ring canal as the main means. We believe that the normal anatomy and physiological function of the inguinal and femoral ring area cannot be restored to the greatest extent, and in addition, filling the femoral ring canal with polypropylene mesh plugs may cause compression of the femoral vein in the femoral canal, causing deep vein thrombosis in the lower extremity, and may also cause occult femoral hernia. Since the internal diameter of the femoral canal is not exactly the same, it is not easy to control how to cut the flaps inside the polypropylene mesh plug, which increases the possibility of postoperative complications. The present procedure does not require filling of the femoral annulus-femoral canal, which completely avoids the above problems and significantly reduces the risk of surgery and the possibility of complications. In terms of indications, for the sake of safety, none of the patients we selected had any intussusception or strangulation; however, it has been reported in the literature that tension-free repair of an intussusception hernia without intestinal necrosis or local infection can be considered using a polypropylene patch, which can be further discussed.