Hernia Repair, Femoral

Introduction

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.

What causes a femoral hernia?

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.

Why is surgery needed?

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.

How is the surgery performed?

There are two ways that a femoral hernia repair can be performed:

Open surgery – where one large cut is made to allow the Dr. B C Shah to push the lump back into the abdomen
Keyhole surgery – a less invasive but more difficult technique where several smaller cuts are made, allowing Dr. B C Shah 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 Dr. B C Shah’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.

Are there any risks from the operation?

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

For information on other types of hernia see:

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

Dr. B C Shah will make 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.

What are the advantages and disadvantages?

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 damage of 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 Dr. B C Shah 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).
Open surgery is more common than keyhole surgery, partly because not all surgeons have enough experience in keyhole techniques

It is recommended 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 it 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.

Looking after yourself

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.

Activities

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 Dr. B C Shah 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.

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.