Femoral hernia repair

Your abdominal cavity contains your intestines and other structures.

These are protected by your abdominal wall, which is made up of four layers.

Weak spots can develop in the layer of muscle wall, resulting in the contents of your abdomen (along with the inner layer) pushing through your abdominal wall.

This produces a lump called a hernia. A femoral hernia causes a lump low down in your groin, close to your lymph nodes.

It happens at the hole in the wall of your abdomen where the femoral artery and vein pass from your abdomen into your leg.

Femoral hernias in women (particularly older women) are more common than femoral hernias in men. This is because of the wider shape of the female pelvis.

Femoral hernias occur when a piece of intestine pokes through a weakness in the femoral canal, around the groin and abdominal wall, where the femoral artery has more space to move. This can be fixed by femoral hernia surgery.

A build-up of pressure within the abdomen can push a piece of the intestine into the femoral canal (this is tubular passage at the front of your thigh). This pressure can vary from prolonged constipation, swelling of your internal organs (such as the bowels themselves), obesity, or ascites (a fluid build-up in the abdomen). Likewise, pregnancy can cause inguinal hernias in the mother for the same reason.

Straining on the toilet, whether for passing a stool or urinating, can force the intestine to pop out of the femoral canal. If you are giving birth, the likelihood of a femoral hernia developing increases as the pressure on the lower abdomen increases.

Engaging in heavy lifting, such as in the gym, in your workplace, or at home, can increase the risk of developing a femoral hernia. 

Long-term, chronic, or heavy coughs can shock your intestine into pushing through a weak spot around your femoral canal.

It is important to have a femoral hernia treated quickly, as there is a high risk of it becoming strangulated and rupturing within your femoral canal. This is because of the position of the femoral artery (around your groin and leg joint).

A femoral hernia and inguinal hernia are both types of groin hernias, but they are distinct from one another.

An inguinal hernia is the most common type of hernia. It can present as swelling or a lump in your groin. The swelling may be painful.

Inguinal hernias often don't cause any severe symptoms and can be treated effectively with surgery.

Femoral hernias are a more uncommon type of hernia. They can cause more problems because they are more likely to "pinch" a part of the bowel. However, femoral hernias can also be treated effectively through surgery.

How do you know if you have a femoral hernia? In some cases you may not even realise you have a femoral hernia. Small and moderate-sized hernias don’t usually cause any symptoms and in many cases you may not even see the bulge of a small femoral hernia.

Large hernias may be more noticeable and can cause some discomfort. A bulge may be visible in the groin area near your upper thigh. Studies show that inguinal hernias often don't cause any severe symptoms.

Femoral hernias, on the other hand, can cause more problems because they are more likely to pinch a part of the bowel. The condition my lead to symptoms of bowel obstruction or a strangulated hernia. However, these are separate medical conditions.

Yes, femoral hernias can cause pain.

The bulging may become worse and can cause pain when you stand up, lift heavy objects, or strain.

Femoral hernia pain often presents as a painful lump that can worsen significantly.

Femoral hernias are often located very close to the hip bone and as a result may cause hip pain. 

Severe femoral hernia symptoms can signify that a femoral hernia is obstructing your intestines. Severe symptoms of a femoral hernia may include:

• Severe stomach pain;
• Sudden pain in your groin, and
• Nausea and/or vomiting.

Seek immediate medical attention if you suffer from these symptoms. Emergency treatment can fix the hernia and save your life.

A femoral hernia can be generally treated through surgery, either in open surgery or with key-hole surgery (laparoscopically).

Generally, Consultants prefer key-hole surgery as a form of surgical repair. It is quicker, less invasive, and means you can recover quicker. The time between diagnosis and private hernia surgery is often less than a month, ensuring you receive rapid treatment.

Various anaesthetic techniques are possible. The operation usually takes about 45 minutes.

Your surgeon will make a cut either directly over the lump or a little higher up and will remove the hernial sac. They will then narrow the hole (femoral canal) through which the contents of your abdomen passed, using stitches or a synthetic mesh to allow just enough space for the femoral artery and vein.

Our laparoscopic surgery requires a few small incisions around the groin by experienced clinicians. You will be placed under general anaesthetic for the procedure.

Using a lightweight, synthetic mesh, our Consultants push the femoral hernia out of the femoral canal and back into the abdominal cavity. They then cover it in a lightweight synthetic mesh which strengthens the abdominal wall, preventing the hernia from popping out again. This technique is referred to as an umbrella hernia repair.

Previous patients who have received this treatment with mesh have recommended it rather than a manual pulling of the muscles together to heal the weakness, which can be more intrusive. This less invasive surgery takes 45 minutes from start to finish, and is a day case, meaning you can arrive and leave on the day of the surgery.

Risks associated with femoral hernia surgery are generally uncommon, however, they still exist.

Your Consultant will advise you on the following risks: general surgical difficulties, such as blood clots, damage to your internal organs, nerve damage, scarring and infections from the wound.

More pertinent to femoral hernia surgery is that there may be difficulty passing urine or stools after the surgery, as well as temporary weakness around the leg joint and muscles down the leg.

You should no longer have the hernia.

Surgery should prevent the serious complications that a hernia can cause and allow you to return to normal activities.

Surgery is recommended as it is the only dependable femoral hernia cure.

It will not get better without surgery.

Like all surgical procedures, there are some levels of risks to consider. Some of these can be serious and can even cause death.

However, you can speak to your doctor about the following general and specific complications that may worry you.

General complications of any operation

• Pain
• Bleeding
• Infection of the surgical site (wound)
• Unsightly scarring of your skin
• Blood clot in your leg
• Blood clot in your lung

Specific complications of this operation

• Developing a collection of blood (haematoma) or fluid (seroma) under your wound
• Difficulty passing urine
• Injury or narrowing of the femoral vein
• Injury to structures that come from your abdomen and are within the hernia
• Temporary weakness of your leg
• Damage to nerves

You should be able to go home the day of your surgery and return to work after two to four weeks.

This will depend on how much surgery you need and your field of work. With regular exercise, you should be able to return to normal activities as soon as possible.

Before you start exercising, ask the healthcare team or your GP for advice about which exercises will work for you.

A femoral hernia is a common condition caused by a weakness in your abdominal wall, near the femoral canal.

If left untreated, a femoral hernia can cause serious complications.

Book your appointment online, or find out more by calling us on 0141 300 5009.

Acknowledgements

• Author: Mr Simon Parsons DM FRCS (Gen. Surg.)