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Femoral Hernia Repair

A femoral hernia is a type of groin hernia that occurs below the inguinal crease. The inguinal crease is the where the leg meets the abdomen in your abdominal wall.  This type of hernia is less common than inguinal hernias but is, actually, more common in women.  Femoral hernias have a higher likelihood of becoming to become stuck or strangulated. These hernias should almost always be repaired.

A femoral hernia, by definition, occurs below the inguinal crease in your groin while an inguinal hernia occurs above the crease.  They lump or bulge is usually seen with activities of exertion such as exercise, standing, straining, or coughing. The lump can often be pushed back in or will disappear when the patient lies down.

When a person has a femoral hernia, abdominal organs, most commonly the small intestine or omentum (a layer of abdominal fat that coats the abdominal cavity), may protrude through the hole or weakness in the abdominal wall and create a visible lump or bulge. The hole or weakness in the abdominal wall is caused by an erosion of a specific layer of the abdominal wall, namely the fascia. The erosion of the fascia is usually caused by wear and tear of the abdomen, leading to a hole (much like a bulge that forms in a tire from the wearing away of the tire’s outer layer). A hernia is truly a hole in the abdominal wall fascia.

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 causes a femoral hernia?

Hernias can occur anywhere in the abdomen. However, they are most common in the groin and navel – bellybutton – since they are the weakest parts of the abdominal fascia. Once a hernia forms, there can be no improvement without surgical intervention. A hernia cannot repair itself. One the hole (or hernia) forms, fascia will not regrow to close the hole.

Over the course of our lives, areas of weakness can also form as a result of various conditions including:

  • Obesity
  • Injuries
  • Pregnancy
  • Age
  • Colon cancer
  • Prostate problems
  • Straining
  • Exercise

Signs and Symptoms of a Femoral Hernia

You may not even realize you have a femoral hernia in some cases. Small- to moderate-sized hernias do not usually cause any symptoms. In many cases, you may not even see the bulge of a small femoral hernia.

Large hernias may be more noticeable and can cause some discomfort. A bulge may be visible in the groin area near your upper thigh. The bulging may become worse and can cause pain when you stand up, lift heavy objects, or strain in any way. Hip pain can also be a symptom of a femoral hernia due to its location.

Severe symptoms can indicate that a femoral hernia is obstructing your intestines. In this case, blood flow to the intestines can be cut off. This is a very serious condition called strangulation. Strangulation causes intestinal and bowel tissue to die, which can put your life in danger. Symptoms of hernia can include stomach pain, nausea, and vomiting. Seek immediate medical attention if you suffer from these symptoms. Emergency treatment can fix the hernia and save your life.

When is surgery required for a femoral hernia?

Almost all femoral hernias should be repaired as there is a higher risk of complications developing in these types of hernias.  When a person has a femoral hernia, abdominal organs, most commonly the small intestine or omentum (a layer of abdominal fat that coats the abdominal cavity), may protrude through the hole or weakness in the abdominal wall and create a visible lump or bulge. This lump or bulge is usually transient as the bowel or omentum can pass back through the hole and return to the abdomen.

Complications occur when the lump persists and pain develops. This can be due to: 1) an obstruction or blockage – when a part of the bowel becomes stuck in the hernia, which leads to nausea, vomiting and stomach pain, and/or 2) strangulation – when the bowel’s blood supply becomes cut off by being stuck in the hernia. Either condition requires emergency surgery to release the bowel trapped in the hernia to relive the obstruction or blockage and to restore the bowel’s blood supply so it does not die.

Hernias do not heal on their own or “just go away” and cannot be fixed with some sort of diet or exercise. The safest, most effective way to repair a hernia is with mesh in a tension-free method. This repair can either be performed laparoscopically (through small incisions) or through an open method.

An open or conventional approach to a hernia is done through a three to four inch incision in the skin in the groin (just above the inguinal crease). The incision extends through the skin, and though the subcutaneous fat and muscle in order to get to the level of the hernia or hole. The hernia contents are pushed back or reduced back through the hole. Next, a piece of surgical mesh is placed through the hole to repair the defect or hole. An open hernia repair is usually performed with a local anesthetic and intravenous sedation (a twilight) but may be performed with a general anesthetic.

A laparoscopic hernia repair. In this approach, the hernia is repaired through three tiny incisions in your abdominal wall. Through one incision, a small video camera is inserted in order  to perform the surgery on a video screen. The surgeon operates through the other two incisions with small instruments. The hernia is repaired from behind the abdominal wall. There is no dividing or cutting of any muscle or structures. This leads to less trauma and inflammation and, thus, a quicker and less painful recovery. A piece of surgical mesh is placed over the hernia defect and held in place with small surgical absorbable clips. This operation needs to be performed via general anesthesia.

In either method (laparoscopic or open), a mesh is placed in order to cover the hernia. The hole is not brought together with stitches but rather, covered by a strong surgical mesh.  Thus, the mesh is placed without tension and leads to fewer recurrences. Prior to using this technique, the hernia was closed by sewing the edges of the hole (the hernia) together, This created a great deal of tension and led to many recurrences.

The surgical mesh incorporates itself safely into the abdominal wall. Extending beyond the edges of the original hole or tear, the mesh will not lift or separate later with strenuous physical activity or excessive abdominal straining. The mesh is quite thin and is unable to be felt under the incision.

Dr. Lublin performs a laparoscopic tension-free repair that bridges the hole or weakness with a piece of plastic-like mesh (screen). The mesh is a permanent material that spans the margins of the defect and allows the body’s normal healing process to incorporate it into the local structures. This has proven to be a very effective means of repair.

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