A femoral hernia is similar to an inguinal hernia and occurs in the groin area near the leg crease. It is often painful with an obvious lump.
Who commonly presents with it?
Femoral herniae are far more common in women and increase in incidence with age (typically old, thin women). During pregnancy women put weight on around their hips and upper legs, which stretches the femoral canal. This canal once stretched will allow the passage of fat and at times bowel through it, resulting in a hernia. Commonly the hernia contains a layer of fat, which lies over the bowel, called extraperitoneal fat.
How does it present?
A Femoral hernia usually presents as a painful lump in the skin crease of the leg. It can be difficult to distinguish a femoral hernia from an inguinal hernia in some patients. If irreducible, a femoral hernia will require an immediate/ emergency operation due to possible strangulation of omentum or bowel (incarcerated or strangulated hernia). A patient will notice a very painful hard lump in the groin area in line with the leg skin crease. Like inguinal hernia repetitive coughing or straining, lifting heavy objects can increase the risk of developing a femoral hernia.
What can be done?
A Femoral hernia if presents as a tender irreducible lump is treated as an emergency with surgical repair recommended as soon as possible. The emergency surgery involves a small incision in the skin crease, with repair of the defect with in some case a single stitch. Rarely a mesh is used for the repair and in some cases if bowel is involved a small piece of bowel has to be removed.
Femoral hernia in the non-urgent setting can be repaired by open surgery under either local or general anaesthesia with a small incision over the lump. A mesh can be used if the defect is large, but in most cases no mesh is required with the defect closed using a simple suture technique. Keyhole 'laparoscopic surgery' is also possible for femoral hernia and can be recommended in this scenario and with this repair a mesh is required.
In some cases when a patient undergoes a keyhole inguinal hernia repair a co-existing femoral hernia is identified and can be repaired at the same time.
Your Surgeon will discuss all the options with you and together a decision will be made on which type of hernia repair will suit you best.
How long will your recovery take?
Recovery is very quick, with most patients being discharged the same day. Patients are encouraged to start mobilising immediately after surgery and refrain from lifting heavy objects for at least two weeks and heavy-duty activity for a possible further month. A return to full regular activities is expected within 1 week.
What are the main risks of surgery?
Your surgeon will advise on any specific complications and risks. For all types of surgery there is always a risk of bleeding in the abdominal wall and/ or groin, very rarely bleeding requires any intervention such as surgery. Older patients may find more ‘swelling’ in the area previously occupied by the hernia known as ‘dead space’ (artificial space created by the hernia protrusion), which can be in the groin as well as the scrotum (in men). The ‘dead space’ fills with fluid especially in the scrotum, and requires support with ‘tight’ undergarments but not too ‘tight’! This swelling is called a seroma and settles in most patients in 1-3 months with some persisting longer. Occasionally a small bleed into a seroma presents with a haematoma or bruise, this again settles in time but can be unsightly for at least the first 4-6 weeks after surgery especially if in the scrotum, therefore, supportive undergarments are again suggested.
Another complication includes wound infection and a 1-2% risk of recurrence of the hernia. Specifically for femoral hernia surgery the risk of groin pain and numbness is quoted as a long term risk seen in up to 2-6% of patients.
Men of increasing age can in some cases have difficulty in passing urine especially after keyhole hernia repair, this is because the prostate gland can swell. Some patients require a catheter passed into the bladder and may also need some medication, but this is temporary and in most patients the catheter can be removed after 24-48 hours. Very rarely a specialist in urology will be needed for advice.
The risks of underlying bowel complications are rare and are mainly associated with the keyhole (laparoscopic) technique and if they occur, are commoner with the TAPP over the TEP method.
Other very rare complications that have been described in the literature include injury to major blood vessels and the bladder but these again are predominantly associated with the keyhole (laparoscopic) technique.