Femoral Hernia Repair
WHAT IS A FEMORAL HERNIA?
- A hernia occurs when the inside layers of the abdominal muscle have weakened, resulting in a bulge or tear. In the same way that an inner tube pushes through a damaged tire, the inner lining of the abdomen pushes through the weakened area of the abdominal wall to form a small balloon-like sac. This can allow a loop of intestine or abdominal tissue to push into the sac. The hernia can cause severe pain and other potentially serious problems that could require emergency surgery.
- A femoral hernia comes through the femoral canal where the femoral vessels and nerves pass into the thigh.
- Femoral hernias account for 5% of abdominal wall hernias.
- Both men and women can get a femoral hernia but women are about twice as likely to develop this type of hernia.
- A hernia does not get better over time, nor will it go away by itself.
- Complications of femoral hernias such as incarceration, obstruction and strangulation do occur but at a very low rate.
HOW DO I KNOW IF I HAVE A FEMORAL HERNIA?
- The femoral hernias occur in the groin but present below the inguinal ligament.
- It is usually easy to recognize a femoral hernia but it is hard to distinguish it from an inguinal hernia. You may notice a bulge under the skin in the groin. You may feel pain when you lift heavy objects, cough, strain during urination or bowel movements, or during prolonged standing or sitting.
- The pain may be sharp and immediate or a dull ache that gets worse toward the end of the day.
- Severe, continuous pain, redness, and tenderness are signs that the femoral hernia may be entrapped or strangulated. These symptoms are cause for concern and immediate contact of your physician or surgeon.
WHAT CAUSES A FEMORAL HERNIA?
The wall of the abdomen has natural areas of potential weakness. Hernias can develop at these or other areas due to heavy strain on the abdominal wall, aging, injury, an old incision or a weakness present from birth. Anyone can develop a femoral hernia at any age. In adults, a natural weakness or strain from heavy lifting, persistent coughing, straining with bowel movements or urination can cause the abdominal wall to weaken or separate. In the femoral region, there is a natural weakness at the femoral canal, the site that the femoral vessels pass into the thigh from the abdomen.
WHAT ARE THE OPTIONS FOR REPAIR?
There are few options available for a patient who has an femoral hernia. Femoral hernias typically enlarge over time and become more symptomatic. This is a type of hernia that is frequently incarcerated and strangulation tf the hernia is a high risk. Most femoral hernias require a surgical procedure at some point in time.
The open approach is done from the outside through an incision over the palpable hernia. The incision will extend through the skin and subcutaneous fat; this allows the surgeon to get to the level of the defect. The defect is usually patched or plugged with a piece of surgical mesh. This technique is usually done with a local anesthetic and sedation but may be performed using a spinal or general anesthetic.
The laparoscopic approach usually requires three small incisions; the largest at the umbilicus for the video camera trocar and two smaller incisions for the operative trocars. A piece of mesh is placed inside the abdominal wall through one of the trocar sites and is held in place with surgical tacks or small absorbable hooks incorporated in the mesh. This operation is usually performed with general anesthesia but can occasionally be done using regional or spinal anesthesia.
WHAT ARE THE ADVANTAGES OF THE OPEN FEMORAL HERNIA REPAIR?
The open approach to femoral hernia repair is typically done under local anesthesia with sedation. In patients with heart disease or some other conditions which increase the risks of a general anesthetic; this may represent a significant advantage over the laparoscopic approach. The open and laparoscopic procedures both typically use mesh for the repair. There are fewer intra-abdominal complications with the open approach but these types of complications are very rare. Return to work times are very similar for the two approaches and both are done as an outpatient.
WHAT PREPARATION IS REQUIRED?
- Most hernia operations are performed on an outpatient basis, and therefore you will probably go home on the same day that the operation is performed.
- Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition.
- After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
- It is recommended that you shower the night before or morning of the operation.
- If you have difficulties moving your bowels, an enema or similar preparation may be used after consulting with your surgeon.
- After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon has told you are permissible to take with a sip of water the morning of surgery.
- Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and Vitamin E will need to be stopped temporarily for several days to a week prior to surgery.
- Diet medication or St. John’s Wort should not be used for the two weeks prior to surgery.
- Quit smoking and arrange for any help you may need at home.
HOW IS THE OPEN PROCEDURE PERFORMED?
Most femoral hernias require surgical repair. The open approach is done from the outside through a three to four inch incision in the groin or the area of the hernia. The incision will extend through the skin, subcutaneous fat, and allow the surgeon to get to the level of the defect. The contents of the hernia are reduced back into the abdomen. Frequently in femoral hernias the surgeon has to enlarge the defect in order to reduce the hernia. The surgeon will usually choose to use a small piece of surgical mesh to repair or plug the defect or hole. This technique is usually done with a local anesthetic and sedation but may be performed using a spinal or general anesthetic.
WHAT SHOULD I EXPECT AFTER SURGERY?
- Following the operation, you will be transferred to the recovery room where you will be monitored for 1-2 hours until you are fully awake.
- Once you are awake and able to walk, you will be sent home.
- With any hernia operation, you can expect some soreness mostly during the first 24 to 72 hours.
- You are encouraged to be up and about the day after surgery.
- You will probably be able to get back to your normal activities within a short amount of time. These activities include showering, driving, walking up stairs, lifting, working and engaging in sexual intercourse.
- Call and schedule a follow-up appointment within 2 weeks after you operation.
WHAT COMPLICATIONS CAN OCCUR?
- Any operation may be associated with complications. The primary complications of any operation are bleeding and infection but these are uncommon with femoral hernia repair.
- There is a slight risk of injury to the urinary bladder, the intestines, blood vessels and nerves.
- Difficulty urinating after surgery is not unusual and rarely may require a temporary tube into the urinary bladder for as long as one week.
- Any time a hernia is repaired it can come back. This long-term recurrence rate is very low. Your surgeon will help you decide if the risks of laparoscopic hernia repair are less than the risks of leaving the condition untreated.
WHEN TO CALL YOUR DOCTOR
Be sure to call your physician or surgeon if you develop any of the following:
- Persistent fever over 101 degrees F (39 C)
- Increasing abdominal or groin swelling
- Pain that is not relieved by your medications
- Persistent nausea or vomiting
- Inability to urinate
- Persistent cough or shortness of breath
- Purulent drainage (pus) from any incision
- Redness surrounding any of your incisions that is worsening or getting bigger
- You are unable to eat or drink liquids