What is a Femoral Hernia Repair?
Femoral hernia repair is a surgical procedure performed for the treatment of a medical condition called a femoral hernia.
A hernia is a bulge that forms when the organs of the abdominal cavity push out through a weak spot in the abdominal wall. The muscles of your abdominal wall are strong and tight enough to keep the internal organs in place; but muscle weakness, previous abdominal surgery, or induced pressure in the abdominal wall may result in a hernia.
A femoral hernia is a bulge that forms when a part of the peritoneal sac (abdominal wall), consisting of fatty tissue, intestine, or other structures, protrudes and is visible just below your lower abdomen and upper thigh, near your groin crease or labia (skin folds around the vagina). The bulge is pushed into your femoral canal through which your nerves and blood vessels run into the thigh region.
During a femoral hernia repair, your surgeon pushes the hernia back into the abdomen and the weakened abdominal wall area is sewn closed or strengthened with a synthetic mesh. This is performed either through an open surgery or a minimally invasive laparoscopic surgery.
Indications for Femoral Hernia Repair
Your physician may recommend femoral hernia repair when your hernia is causing severe pain and other associated symptoms that are affecting your daily activities. Sometimes, the intestine may get obstructed (stuck in the femoral canal) or strangulated (trapped). Strangulation may block blood flow to the part of your intestine that is stuck and cause tissue necrosis (death of tissue) which may endanger your life. A trapped or obstructed femoral hernia may cause the following symptoms:
- Increased heart rate
- Tenderness/sudden quick intensifying pain in the groin or abdomen
- Reddish or bluish discolouration of the bulge
- Nausea and vomiting
The presence of these symptoms requires an emergency hernia repair to release the trapped tissue.
Preparation for Femoral Hernia Repair
Preoperative preparation for femoral hernia repair will involve the following steps:
- A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to the surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
- You will be asked if you have allergies to medications, anaesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You may need to refrain from medications such as blood thinners or anti-inflammatories for 1 to 2 weeks prior to surgery.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- You should shower with an antibacterial soap the night or morning prior to the operation.
- You should arrange for someone to drive you home after surgery.
- A signed informed consent form will be obtained from you after the pros and cons of the surgery has been explained.
Procedure for Femoral Hernia Repair
Your surgeon may perform either an open or a laparoscopic surgery to repair the femoral hernia. These procedures will be performed under the influence of general or local anesthesia.
Open Femoral Hernia Repair
During the procedure, a single 3 to 4 cm long incision will be made over the bulge or in your lower abdomen and the bulge will be separated from the surrounding tissues. Your surgeon may remove any excess tissue if required. The part of your protruded peritoneal sac will be pushed back into the abdomen. The muscles of the weak abdominal wall may either be stitched (Herniorrhaphy) or a piece of mesh may be sutured (Hernioplasty) in place to strengthen it. At the end of the repair, the incision is stitched closed.
Laparoscopic Femoral Hernia Repair
Laparoscopic surgery, also called keyhole surgery, is a minimally invasive surgical method that uses a device called a laparoscope (a small thin tube with a light and tiny video camera connected to a television monitor), which helps visualise the internal organs during the operation.
During laparoscopic repair, your surgeon will make a few small incisions in your abdomen or groin through which a laparoscope and other special instruments are inserted. A video camera attached to the laparoscope sends magnified images to a monitor guiding your surgeon throughout the procedure. Your surgeon will push the bulge back into the abdomen and either stitch the abdominal wall or use a mesh to support the weakened wall. Once the repair is complete, the scope and other tools are withdrawn, and the small keyhole incisions are closed with stitches or surgical tape.
Advantages of a laparoscopic procedure over the open surgical method include shorter hospital stays, smaller incisions, less post-operative pain, and a faster recovery.
Postoperative Care Instructions and Recovery
In general, postoperative care instructions and recovery after femoral hernia repair will involve the following steps:
- You will be transferred to the recovery area where your nurse will monitor your vital signs as your recover from the effects of anaesthesia.
- Most patients are able to go home the same day or the next day if it is a laparoscopic procedure or after two to three days if it is an open surgery.
- You may notice some pain, swelling, and discomfort in the groin or upper thigh area. Pain and anti-inflammatory medications are provided as needed.
- Antibiotics are also prescribed to address the risk of surgery-related infection.
- You are encouraged to walk with assistance as frequently as possible to prevent the risk of blood clots.
- Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
- Refrain from strenuous activities, lifting heavy weights, and driving at least for the first few weeks. A gradual increase in activities over a period of time is recommended.
- Typically, you will be able to return to work and resume your daily activities in a week or two after surgery.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications of Femoral Hernia Repair
Femoral hernia repair surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Infection at the incision site or mesh
- Postoperative pain
- Blood or fluid accumulation
- Anaesthetic reactions
- Recurrence of hernia
- Blood clots
- Injury to surrounding soft-tissue structures or organs
- Urinary retention