Femoral hernias account for less than 5% of all abdominal wall hernias. They occur almost twice as often in women than men and are more likely to require emergency repair as the weakened area is small and more likely to trap contents in it (incarceration), cut off the blood supply of it’s contents (strangulation)or block the bowel (intestinal obstruction).Forty percent of patients with a femoral hernia are admitted as an emergency with strangulation or incarceration, and it is therefore important to differentiate between femoral and other types of hernia.
Symptoms of femoral hernia
Femoral hernias usually present with a painful bulge in the groin at the skin crease between the leg and the abdomen. Symptoms can be worsened when coughing, sneezing or when taking exercise. Sometimes the painful bulge cannot be pushed back in and the hernia has to operated on as an emergency.
Causes of femoral hernia
Femoral hernias are more likely in women who have been pregnant before.The femoral canal (where the hernia occurs) stretches during pregnancy, increasing the risk.
There may be no obvious cause but femoral hernias may be more common in association with heavy lifting, straining (constipation or difficulty in passing urine), pregnancy or with strenuous exercise.
Treatment of femoral hernia
Femoral hernias should be repaired to relieve symptoms and prevent the risk of complications (see below).
Femoral hernia repair is a day case operation meaning that no overnight stay in hospital is necessary. These repairs are carried out under general anaesthetic.
1. The conventional (or open) approach involves a small incision just over the swelling. The weakness in the abdominal wall is repaired –a nylon mesh is not always required. The incision is closed with an invisible dissolving stitch.
2. A laparoscopic (keyhole) repair can be carried out from within the abdomen. Very small incisions are made in the abdominal wall to enable specialist keyhole instruments to be inserted. These are then used to repair the weakness and insert a nylon mesh.
Your surgeon will discuss these options with you.
You will usually have a pre-op assessment in the week before surgery where blood tests, chest X-ray and an ECG (heart recording) may be taken. You will be admitted a few hours before the approximate planned time of surgery having had nothing to eat for six hours before the start time (you may drink water up to two hours before your proposed time of surgery – with any of your regular medications). You will see your surgeon and the anaesthetist before your operation.
After your surgery you will wake up in the recovery room, and then be transferred back to the ward. Later the same day you may have something to eat and drink if you wish. Most people are discharged home later the same day.
You will be provided with painkillers before discharge but it is recommended that you take regular paracetamol and ibuprofen (unless you are sensitive to these) after a few days of these. Stronger painkillers such as cocodamol may be necessary but if so it is important to take a laxative such as lactulose at the same time. You can expect to have some discomfort after surgery, but this will rapidly subside and most people are able to resume normal activities within a week of surgery. It may be slightly more uncomfortable for longer if you have had an open procedure. With both types of surgery there will still be minor twinges for some time as the tissues organize themselves. You will be able to take gentle exercise but should avoid heavy lifting or strenuous work for 2 weeks. You may drive a car when you are able to perform an emergency stop safely. There are no stitches to be removed.
You will be seen for follow-up six weeks following your surgery.
Risks of surgery
There are very few potential complications.You may develop some bruising around your groin. If the wound swells, becomes more painful and hot, or starts to discharge, you may have a wound infection and should contact the Berkshire Hernia Centre or your General Practitioner. The risk of recurrence is around 1-2%.