femoral

FEMORAL HERNIA

This is the 3rd most common hernia after the 2 types of inguinal hernia (direct and indirect). It accounts for 6% of all abdominal wall hernias. It is more common in women.

This figure and photograph show the position of femoral hernias.

The hernia sac pushes through a hole called the 'femoral canal'. This is surrounded on 3 sides by very tough tissues. These hernias, therefore, tend to stay once they occur and have a higher risk of strangulation. I repair these hernias on an urgent basis.

A rare variety is the 'prevascular femoral hernia'. This comes down in front of the vessels in the groin and is easy to push back in. It rarely strangulates.

Repair

In elective operations I repair these hernias with a cut directly over the hernia. The sac is identified and reduced. I repair the defect (femoral canal) with a rolled up piece of plastic mesh held in place with permanent stitches. The skin is closed with a dissolving stitch. The operation can be done under local anaesthetic (injections around the hernia to make that area numb without putting you to sleep). The wound is usually dressed with a special glue dressing (Dermabond) - this is water resistant and means you can have a shower the following day. It is also see-through allowing for wound inspection.

In emergency cases where there is a worry that the hernia may contain a piece of strangulated bowel, I approach the hernia through a cut in the lower abdomen. This allows me to approach the hernia from behind the abdominal muscles and gives more access if the bowel needs to be dealt with (the damaged piece may need to be removed and the rest joined up again). The defect (femoral canal) can be repaired from inside by a rolled up piece of mesh or by stitches if I am worried about the possibility of the mesh getting infected.

Complications

Usually the operation is straightforward. Possible complications include:

	Damage to the contents of the hernia sac.
	Damage to the femoral vein (runs next to the hernia).
	Deep vein thrombosis - this is possible after any operation.
	Wound infection - this is usually superficial and settles rapidly with antibiotics.
	Recurrence - possible after any hernia operation.

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