Overview of Femoral Hernia Surgery

A femoral hernia happens when a weakness in the muscle of the groin allows the intestine to bulge through. The first sign of a femoral hernia is usually an unexplained bulge in the groin area or the upper thigh area. It is usually something that develops over time, not something that a person is born with.

It can be difficult to determine if a hernia is a femoral hernia or an inguinal hernia. They are only differentiated by their location relative to the inguinal ligament. A hernia in the groin area that is above the inguinal ligament is an inguinal hernia; below the ligament, it is a femoral hernia. It often takes a specialist to determine what type of hernia is present and it may only be identified once surgery begins.

Causes

Repetitive or constant straining to have a bowel movement can cause a hernia, as can straining to urinate, as often happens with prostate problems. A chronic cough, from lung disease or from smoking, can increase the chances of developing a hernia.

Obesity can increase the risk of developing a hernia, and losing weight may prevent a hernia from forming or growing in size.

Risk Factors

Femoral hernias are most common in women, although they can develop in men and children. Older women and women who are very small or thin are at higher risk for developing a femoral hernia.

Symptoms

A femoral hernia will not heal by itself and requires surgery to be repaired. Initially, the hernia may only be a small lump in the groin, and it can grow much larger over time. It may also appear to grow and shrink with different activities.

Increased abdominal pressure during activities such as straining to have a bowel movement or sneezing may push more of the intestines into the herniated area, making the hernia appear to grow temporarily.

When It's an Emergency

A hernia that gets stuck in the “out” position is referred to as an incarcerated hernia. This is a common complication of femoral hernias. While an incarcerated hernia is not an emergency, it requires medical attention.

An incarcerated hernia is an emergency when it becomes a “strangulated hernia” where the tissue that bulges outside of the muscle is being starved of its blood supply. This can cause the death of the tissue that is bulging through the hernia.

A femoral hernia has a higher risk of incarceration and strangulation than an inguinal hernia and thus has to be taken very seriously.

Treatment

Femoral hernia surgery is typically performed using general anesthesia and can be done on an inpatient or outpatient basis. The surgery is performed by a general surgeon.

After anesthesia is given, surgery begins. Surgery may be done laparoscopically (often described as minimally invasive) or with an open procedure.

• An open femoral hernia repair, the more common technique, begins with an incision in the groin. The intraabdominal contents are reduced back into the abdomen, and mesh is used to reinforce the area.
• With laparoscopic surgery, an incision is made on either side of the hernia. A laparoscope is inserted into one incision, and the other incision is used for additional surgical instruments. The surgeon isolates the portion of the abdominal lining that is pushing through the muscle. This tissue is called the “hernia sac.” The surgeon returns the hernia sac to its proper position inside the body and begins to repair the muscle defect.

If the defect in the muscle is small, it may be sutured closed. Suture repair of hernias is done very uncommonly in the US due to its high rates of recurrence.

Usually, a mesh graft will be used to cover the hole. The mesh is permanent and prevents the hernia from returning, even though the defect remains open.

The use of mesh in larger hernias is the standard of treatment, but it may not be appropriate if the patient has a history of rejecting surgical implants or a condition that prevents the use of mesh.

Once the hernia is repaired, the incision can be closed. The incision can be closed in one of several ways. It can be closed with sutures that are removed at a follow-up visit with the surgeon, a special form of glue that is used to hold the incision closed without sutures, or small sticky bandages called steri-strips.

Recovery

Most hernia patients are able to return to their normal activity within two to four weeks. The area will be tender, especially for the first week. During this time, the incision should be protected during activity that increases abdominal pressure. This can be done by applying firm but gentle pressure on the incision line.

Activities that indicate the incision should be protected include:

• Moving from a lying position to a seated position, or from a seated position to standing
• Sneezing
• Coughing
• Bearing down during a bowel movement
• Vomiting