Hernia is a protrusion of a piece of tissue or a loop of bowel, through a weak spot or opening in the abdominal wall. A femoral hernia is a type of hernia that bulges out of a weak spot in the groin region. A Femoral Hernia Repair or a Femoral Herniorrhaphy is a surgical procedure performed to repair the femoral hernia. This surgical procedure may be performed anywhere in the groin region, or inner aspect of the upper thigh.
What are the reasons behind a femoral hernia repair surgery?
How a femoral hernia repair surgery is performed?
- A Femoral Hernia Repair procedure is performed, to reduce the patient's risk of a future surgical emergency. If a repair is not performed, the hernia may reduce or become irreducible, obstructed, or strangulated.
- A reducible femoral hernia occurs, when a femoral hernia can be pushed back into the abdomen, either spontaneously or with manipulation. This is the most common type of femoral hernia and is usually a painless condition
- An irreducible femoral hernia occurs, when the hernia becomes stuck in the femoral canal. This can cause pain and a feeling of illness
- An obstructed femoral hernia occurs, when a part of the intestine enters the hernia sac and gets blocked, causing an intestinal obstruction
- A strangulated femoral hernia occurs, when the hernia blocks blood supply to part of the bowel. If the herniated bowel has its blood supply diminished, because of pressure from other nearby organs or structures, the affected tissue can die and be invaded by bacteria. This is a life-threatening surgical emergency condition
- Femoral hernias are more likely to become incarcerated or strangulated, than other hernias, because the affected tissue pushes through a relatively small and closely confined space
There are two kinds of Femoral Hernia Repair: Open Repair of Femoral Hernia and Laparoscopic Repair of Femoral Hernia.
Open Repair of Femoral Hernia
Laparoscopic Repair of Femoral Hernia
- An incision is made in the groin
- The femoral hernia sac is identified and separated from the tissues around it
- The sac is then pushed back into the abdomen
- The defect is then obliterated, either by approximation of the adjacent tissue, or by placement of a prosthetic mesh
- In case of an incarcerated femoral hernia, the sac is opened and contents are examined for viability
- In cases of compromised bowels, mesh placement is contraindicated, due to an increased risk of mesh infection
- Using a narrow tube-like instrument (cannula), the surgeon enters the abdomen in the area of the belly button (TAPP - Trans Abdominal Pre-Peritoneal approach), or in-between the two muscle layers of the abdominal wall (TEP - Totally Extra Peritoneal approach)
- A laparoscope (a tiny telescope) connected to a special camera is inserted through the cannula, giving the surgeon a magnified view of the patient's internal organs on a television screen
- Other cannulas are inserted, which allow the surgeon to delicately separate the sac from the adjacent tissues
- Once the sac is separated, the defect is identified and covered with a piece of prosthetic mesh
- Laparoscopic repair is not performed in cases of strangulated hernia, where bowel viability is compromised
A femoral herniorrhaphy procedure is performed by a physician trained in general surgery
, assisted by an anaesthesiologist The time for the femoral hernia repair procedure may take anywhere between 1-2 hours.
Preparations required before a femoral hernia repair surgery
Diagnostic lab tests before a femoral hernia repair surgery
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
- Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
- Blood tests may be performed to determine, if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- Do inform the physician if you are allergic to any local anaesthetics, lidocaine, etc.
- Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For persons suffering from diabetes, it is important that the blood sugar stays within the normal range if not their diabetologist may have to control blood sugar by recommending insulin or a combination of oral medicines
Risks and complications during femoral hernia repair surgical procedure
- The diagnosis is largely a clinical one, generally done by physical examination of the groin region
- However, in some patients (especially obese patients), imaging in the form of ultrasonography, CT or MRI scans, may aid in the diagnosis
- As females are more prone to this type of hernia, an abdominal X-ray showing small bowel obstruction in a female patient with a painful groin lump, needs no prompt treatment
The possible risks or complications that may arise during the repair of femoral hernia are:
Risks and complications after femoral hernia repair surgical procedure
Post femoral hernia repair procedure, the following complications may arise:
Post-operative care needed after a femoral hernia repair surgical procedure
At home, the following post-operative care is recommended, after a femoral hernia repair procedure:
- For a few hours after the surgery, have a diet consisting only of liquids or semi-solids
- Avoid strenuous physical activities for a certain period of time, before slowly getting back to your regular daily routine
- Keep incision wounds clean and dry
- Complete the prescribed course of medications
- Avoid taking any pain-killers, unless they are prescribed by your physician
- Take stool softeners to prevent constipation, under advice by the physician
- Take antibiotic medication to help combat or prevent infection, under advice by the physician