Last Updated: 11 December 2018
A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. Usually, your muscles are strong and tight enough to keep your intestines and organs in place. However, sometimes they are not, and this causes a hernia.
A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. Usually, your muscles are strong and tight enough to keep your intestines and organs in place. However, sometimes they are not, and this causes a hernia.
A femoral hernia appears as a painful
lump the size of a large grape in the inner upper part of the thigh or
groin. The lump can often be pushed back in or will disappear when you lie
down. Coughing or straining may make the lump appear.
Site of a femoral hernia in the groin.
A femoral hernia usually occurs when
fatty tissue or a part of your bowel, such as the intestine, pokes through into
your groin at the top of your inner thigh. It pushes through a weak spot in the surrounding
muscle wall (abdominal wall) into the femoral canal. The femoral canal
is a channel through which blood vessels pass to and from your leg.
Straining, for example when on the
toilet, increases pressure inside the abdomen and can trigger a hernia. Other
triggers include:
- obesity
- a smoker’s cough
- constipation
- carrying or pushing heavy loads.
Femoral hernias occur far more
frequently in women, particularly older women, because of the wider shape of
the female pelvis. They rarely occur in children.
A femoral hernia repair is an operation
to push the bulge back into place and to strengthen the abdominal wall. The
operation is necessary as a femoral hernia is a potentially dangerous
condition. The section of bowel can become:
- stuck in the femoral canal, causing an
obstruction – this causes nausea, vomiting and stomach pain, as well
as a painful lump in the groin
- trapped and have its blood supply cut off
(known as a strangulated hernia) – emergency surgery within hours is
essential to release the trapped tissue and restore its blood supply so it
does not die.
Surgery will get rid of the hernia and
prevent you from having any serious complications that a hernia can cause.
There are two ways that a femoral
hernia repair can be performed:
- open surgery – where one large cut
is made to allow the surgeon to push the lump back into the abdomen
- keyhole surgery –
a less invasive but more difficult technique where several smaller cuts
are made, allowing the surgeon to use various instruments
There are advantages and disadvantages
to both methods. The type of surgery you have will depend on which method
suits you and your surgeon’s experience. When recovering from a femoral hernia
repair, you should be able to go home the same day or the day.
However, it's important to follow the hospital's instructions on
how to look after yourself. This includes eating a good diet to avoid
constipation, caring for the wound and not straining yourself too soon.
Femoral hernia repair is a routine
operation with very few risks, although around 1% of femoral hernias will
return after the operation. Although complications due to a femoral
hernia repair are rare, they can include:
- developing a lump under the wound
- difficulty passing urine
- injury or narrowing of the femoral vein (which
passes through the femoral canal)
- injury to the bowel
- temporary weakness of the leg
- injury to the nerves, causing pain or numbness
in the groin area.
Schematic diagram showing the anatomy of the INGUINAL (HESSELBACH'S) TRIANGLE. This is an area of the anterior abdominal wall bounded by the inferior epigastric vessels, inguinal ligament and the lateral border of the rectus abdominis.
Surgical
Repair
How it is performed
There are two ways that a femoral
hernia repair can be carried out. These are known as open surgery or
keyhole surgery (also called laparoscopic surgery).
The operation
The hernia repair should take about 45
minutes. The hospital will send instructions about when you need to stop eating
and drinking before the operation. You will usually be able to go home on
the same day, but some people stay in hospital overnight if they have other
medical problems or live alone.
Open surgery
- The surgeon makes a large (3–4cm) cut in your
lower abdomen or over the hernia.
- The femoral canal (a channel near your bowel)
is opened to return the fatty lump or loop of bowel to your abdomen, where
it should be.
- The canal is closed with a mesh plug to
repair the weak spot that let the hernia through.
- The wall of your abdomen may be strengthened
by fixing a patch of nylon mesh to it.
- If the hernia has become trapped
(strangulated) and part of the bowel damaged, the affected segment may
need to be removed and the two ends of healthy bowel rejoined.
- This is a bigger operation and you may need to
stay in hospital for four to five days.
Keyhole (laparoscopic) surgery
- With keyhole surgery, three very small cuts
are required – one (1.5cm) below the belly button and one (0.5cm)
either side of it.
- A specially designed camera and instruments
are used to push the fatty lump or loop of bowel back into your abdomen.
- The hernia is repaired from the inside using a
mesh patch in the same way as with open surgery.
Illustration of how laparoscopic (keyhole) repair of femoral hernia is performed.
What are the advantages and disadvantages?
The National Institute for Health and
Clinical Excellence (NICE), which assesses medical treatments for the NHS, says
that both keyhole and open surgery for hernias are safe and work well. With keyhole surgery, there is usually
less pain after the operation because the cuts are smaller, there is no
muscle damage with a mesh repair and the small cuts can be closed with
glue.
However, the risks of serious
complications, such as the surgeon accidentally damaging the bowel, are also
higher in keyhole surgery. The risk of your hernia returning is
similar for both operations. Discuss the advantages and disadvantages of
keyhole surgery and open surgery with your surgeon before deciding on the most
appropriate treatment.
Open surgery or keyhole?
Your choice will depend on:
- Whether you can have a general anaesthetic.
Elderly people or people in bad health may be too weak or frail to safely
have a general anaesthetic, so may be advised to have open surgery, which
can be done under local anaesthetic (where the area is numbed).
- The experience of your surgeon. Open surgery
is more common than keyhole surgery, partly because not all surgeons have
enough experience in keyhole techniques. According to NICE, a surgeon is
inexperienced if they have done the operation fewer than 20 times.
NICE recommends that keyhole surgery
should always be considered if the hernia has been repaired before and comes
back. This is known as a recurrent hernia. Keyhole surgery is especially useful if
your surgeon is not sure what type of hernia you have.
Recovering from surgery
You should be able to go home on
the day of or the day after your operation. Get an adult to take you
home in a car or taxi and follow any instructions you are given in hospital. You will not feel any pain while your
hernia is being repaired, but your groin will feel sore and uncomfortable
afterwards. You will be given painkillers to relieve this discomfort.
An adult must stay with you for the
first 24 hours after your operation. Follow these tips to ensure your
recovery is as quick as possible. Follow the instructions your nurse gave you
about caring for your wound, hygiene and bathing.
- If you are still in pain, continue taking
painkillers as advised by the hospital.
- Eat plenty of vegetables, fruit and high-fibre
foods such as brown rice, wholemeal bread and pasta. This helps avoid
constipation, which may cause pain in your wounds from straining.
- Limit your activities to what you can
comfortably handle, but remember that it's important to remain mobile.
- Avoid lifting for two weeks.
A general anaesthetic (which puts
you to sleep during your operation) can affect your coordination and reasoning
skills, so avoid alcohol, operating machinery or signing legal documents for at
least 48 hours. Speak to the medical professional who is
in charge of your care for advice about when you can drive.
It will usually be
at least one to two weeks before you can drive after having keyhole surgery and
two to six weeks after having open surgery. You must not drive before you are
pain free. You may want to contact your car insurance company before returning
to the wheel.
It usually takes 10–15 days to get back
to activities such as shopping. You may recover faster if you had keyhole
surgery. You should be able to return to work
after two to four weeks, depending on the extent of the surgery and your type
of work.
Gentle exercise can help the healing
process, but avoid heavy lifting or anything too strenuous. You may find sex painful or
uncomfortable at first, but it is fine to have sex when you feel like it.
Source: NHS Choices.
Source: NHS Choices.