A femoral hernia occurs when a lump of gut or fatty tissue protrudes through a weak spot in the abdominal muscles, passes through a channel in the groin, known as the femoral canal, and appears as a bulge in the upper thigh. Management of the condition usually involves carrying out a surgical procedure known as a femoral hernia repair. During the operation, the hernia is pushed back inside the abdomen and the opening is repaired with stitches and, sometimes, a piece of mesh is used to strengthen the weak spot. Most often a general anesthetic is required, so the patient is asleep, and the procedure may involve open surgery, using a large incision, or keyhole surgery, where small cuts are made and recovery is quicker.
Femoral hernia repair surgery is normally carried out because of the risk of a strangulated femoral hernia occurring. A strangulated hernia is one in which the blood supply to the piece of tissue or bowel becomes cut off, possibly leading to tissue death which could have fatal consequences. Another reason for femoral hernia repair is to prevent an obstructed femoral hernia from developing. Intestinal obstruction can happen if the hernia contains a section of bowel which becomes blocked, leading to symptoms of pain, nausea and vomiting.
When open surgery is used to carry out femoral hernia repair, a large incision is made and the femoral canal is opened up. The protruding piece of gut or tissue is returned to its original position inside the abdomen. Next, the femoral canal is repaired and a section of mesh may be used to reinforce the abdominal wall.
While what is called a reducible femoral hernia can be pushed back into place by the surgeon, an irreducible femoral hernia cannot. Usually this is the result of strangulation or obstruction. A strangulated hernia is treated as an emergency and surgery is performed straight away to remove the damaged section of gut and join the two healthy ends back together.
If laparoscopic surgery, or keyhole surgery, is used for a femoral hernia repair, about three cuts are made at the beginning of the operation, but they are small compared with the incision made in open surgery. Smaller cuts mean less pain and scarring after the operation, and the recovery period is shorter. A flexible instrument containing a camera and special surgical tools are inserted through the openings in the abdomen to repair the hernia, with images being sent back and displayed on a screen. As in open surgery a mesh may be used to strengthen the weak spot where the hernia emerged.
The disadvantage of laparoscopic femoral hernia repair is that there is a greater risk of the surgeon accidentally damaging part of the gut. Patients can normally go home on the day of surgery, compared with a hospital stay of a few days for the open technique. With both types of femoral hernia repair there is a small chance that the hernia could return.