Femoral hernia repair
A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall.
Your muscles are usually strong and tight enough to keep your intestines and organs in place, but a hernia can develop if there are any weak spots.
What is a femoral hernia?
A femoral hernia is an uncommon type of hernia. It's estimated that only about one in every 20 groin hernias are femoral hernias, and the rest are inguinal hernias.
Femoral hernias sometimes appear as a painful lump 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 and nerves pass to and from your leg.
Unlike inguinal hernias, femoral hernias occur far more frequently in women, particularly older women. This is because of the wider shape of the female pelvis. Femoral hernias are rare in children.
Femoral hernias can sometimes appear suddenly due to strain on the abdomen, such as straining on the toilet if you have constipation, or carrying and pushing heavy loads. They have also been linked to obesity and having a persistent, heavy cough.
When is surgery needed?
Femoral hernias can be repaired using surgery to push the bulge back into place and strengthen the weakness in the abdominal wall.
Unlike some other types of hernia, treatment of femoral hernias is almost always recommended straight away because there is a higher risk of complications developing in these cases.
Complications that can develop as a result of a femoral hernia include:
obstruction – where a section of the bowel becomes stuck in the femoral canal, causing nausea, vomiting and stomach pain, as well as a painful lump in the groin
strangulation – where a section of bowel becomes trapped and its blood supply is cut off; this requires emergency surgery within hours to release the trapped tissue and restore its blood supply so it does not die
Surgery will get rid of the hernia and prevent any serious complications, although there is a chance of it returning after the operation.
What happens during surgery?
There are two ways that an femoral hernia repair can be performed:
open surgery – where one cut is made to allow the surgeon to push the lump back into the abdomen
keyhole (laparoscopic) surgery – a less invasive but more difficult technique where several smaller cuts are made, allowing the surgeon to use various special instruments to repair the hernia
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.
You should be able to go home the same day or the day after surgery. It is 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.
Most people make a full recovery from femoral hernia repair within six weeks, although many people are able to return to driving, work and light activities within two weeks.
Are there any risks from the operation?
Femoral hernia repair is a routine operation with very few risks, although around 1% of hernias will return after the operation.
Other uncommon complications of femoral hernia repair 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
Complications are more likely if you are over 50 or you have another illness, such as heart disease or breathing problems.
How femoral hernia repair is carried out
There are two ways a femoral hernia repair can be carried out. These are known as open surgery or keyhole surgery (also called laparoscopic surgery).
The hospital will send instructions about when you need to stop eating and drinking before the operation.
Femoral hernia repair is usually carried out under general anaesthetic, which means you will be asleep during the procedure and won't feel any pain.
However, regional or local anaesthetic is sometimes used for open surgery. This means you will be awake during the procedure but the area being operated on will be numbed so you won't experience any pain.
The operation should take about 30-45 minutes to complete and you will usually be able to go home on the same day. Some people stay in hospital overnight if they have other medical problems or if they live alone.
During open surgery to repair a femoral hernia, the surgeon makes a single cut (incision) in your lower abdomen (tummy) or over the hernia. This incision is usually about 3-4cm long.
The femoral canal (a channel containing the main blood vessels and nerves leading to the thigh) is opened and the surgeon will then place the lump of fatty tissue or loop of bowel back into your abdomen.
The femoral canal is then closed with a mesh plug to repair the weak spot that let the hernia through.
The incision in your skin is then sealed with stitches. These are usually a type that dissolve on their own over the days following the operation.
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
During keyhole surgery to repair a femoral hernia, three very small incisions are usually made instead of a single, larger incision. One incision, about 1.5cm long, is made below the belly button and two incisions, about 0.5cm long, are made to the sides of this main incision.
A thin tube containing a light source and a camera (laparoscope) is inserted through the largest of these incisions so the surgeon can see inside your abdomen.
Special surgical instruments are inserted through the other incisions so the surgeon can pull the hernia back into place. As with open surgery, a mesh patch is often used to strengthen the weak spot in the abdomen where the hernia came through.
Once the repair is complete, the incisions in your skin are sealed with stitches or surgical glue.
Which technique is best?
The National Institute for Health and Care Excellence (NICE), 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.
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.
Deciding which technique to use
The choice of technique for femoral hernia repair will largely depend on:
your general health – elderly people or people in bad health may be too weak or frail to safely have a general anaesthetic, so open surgery under local anaesthetic may be advised
the experience of your surgeon – open surgery is more common than keyhole surgery, so not all surgeons have enough experience in keyhole techniques
Keyhole surgery can be useful if your surgeon is not sure exactly what type of hernia you have.
Femoral hernia illustration
3. Femoral hernia protruding through femoral canal
Recovering from femoral hernia repair
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 by the hospital.
After the operation, your groin will feel sore and uncomfortable. You will be given painkillers to help relieve this discomfort.
Looking after yourself
An adult must stay with you for the first 24 hours after your operation in case you experience any problems.
If you are still in pain after going home, continue taking painkillers as advised by the hospital. Applying gentle pressure to your wound using your hand or a small pillow can help make coughing, sneezing and moving between sitting and standing more comfortable.
Make sure you follow the instructions your nurse gave you about caring for your wound, hygiene and bathing before you left hospital.
Straining on the toilet because of constipation can cause pain around your wound. You can reduce your risk of constipation by drinking lots of fluids and eating plenty of vegetables, fruit and high-fibre foods such as brown rice, wholemeal bread and pasta. A mild, over-the-counter laxative may also help.
If the operation was carried out under a general anaesthetic (which puts you to sleep during your operation), your co-ordination and reasoning may be affected for a short time. You should avoid drinking alcohol, operating machinery or signing legal documents for at least 48 hours after any operation involving general anaesthetic.
You can gradually return to your normal activities as soon as you are able to do them without feeling any pain.
Most people are able to do light activities, such as shopping, after one or two weeks. You should also be able to return to work after two or three weeks, although you may need more time off if your job involves manual labour.
Gentle exercise, such as walking, can help the healing process, but you should avoid heavy lifting and strenuous activities for about four to six weeks.
You may find sex painful or uncomfortable at first, but it is usually fine to have sex when you feel like it.
Speak to the medical professional in charge of your care for advice about when you can drive. It is usually advisable to avoid driving until you are able to perform an emergency stop without feeling any pain or discomfort (you can practise this without starting your car).
It will usually be one or two weeks before you reach this point after having keyhole surgery, although it may take longer after open surgery.
It is usually recommended that you contact your car insurance company before starting driving again.
When to call a doctor
Call your surgeon if you develop any of the following symptoms:
persistent fever over 38°C (100.4°F)
increased swelling or pain of your abdomen
pain that is not relieved by painkillers
persistent nausea or vomiting
persistent coughing or shortness of breath
increasing redness surrounding your incisions
difficulty passing urine