A hernia, also known as a visceral hernia, is a hernia where the contents of the abdominal cavity break through to the outside. Due to various causes, the abdominal wall can be weakened so that, for example, parts of the intestine can pass through to the outside. This results in a typical protrusion in the area of the hernia.
In the case of a femoral hernia, a hernia occurs below the inguinal ligament. The protrusion can usually be seen on the inside of the thigh.
Femoral hernias are generally painful. This often quickly leads to an incarceration of parts of the intestine. Therefore, a femoral hernia operation is usually performed.
Congenital femoral hernias are extremely rare, so femoral hernias usually develop in the course of life.
Schematic representation of an abdominal wall hernia © blueringmedia | AdobeStock
Initially, an increase in pressure in the abdominal cavity causes fatty tissue to be pressed into the femoral canal. Such an increase in pressure can occur, for example, after one or more pregnancies or if you are overweight. Normal pressure can also have the same effect in combination with connective tissue weakness , which usually occurs with age. In rare cases, weak points may also have formed as a result of surgery (e.g. after an inguinal hernia operation).
Once the femoral canal has been widened by the fatty tissue, parts of the intestines can also pass through. They may become trapped at the point of passage. The resulting lack of blood flow can cause the trapped parts of the intestine to die.
In 60 percent of cases, femoral hernias occur on the right side. In 20 percent of cases, femoral hernias occur on both sides.
Not all femoral hernias can be recognized at first glance. In severely overweight people, it is sometimes difficult to detect a femoral hernia because the skin and tissue conceal the protrusion.
A femoral hernia otherwise appears as a visible and palpable swelling below the inguinal ligament at the base of the thigh. The inguinal ligament is located between the anterior pelvic bone and the pubic bone.
If the femoral hernia cannot be seen and felt immediately, it may not be discovered until parts of the intestine have already been trapped, which can lead to severe pain - possibly in combination with nausea and vomiting.
If a femoral hernia is suspected but cannot be seen or felt, the doctor will carry out an ultrasound examination (sonography). Sometimes a computer tomography(CT) or MRI scan is also required to diagnose the femoral hernia with certainty.
Surgical treatment of a femoral hernia is usually the only effective therapy. However, surgery is not recommended if the patient is in poor physical condition.
If parts of the intestines are trapped in a femoral hernia, emergency surgery may even be necessary.
Surgery for a femoral hernia can be performed under local or general anesthesia. In the case of a femoral hernia with incarceration, general anesthesia is usually preferred. The surgical incision can then be widened more easily if necessary.
In principle, there are two different techniques for femoral hernia surgery:
There are also
Femoral hernias can be treated on the same day in healthy and fit people, provided they are operated on endoscopically. This means that those affected do not have to plan a hospital stay. They can return home after the femoral hernia operation and the usual post-operative monitoring.
You will then have a wound check two to three days after the femoral hernia operation.
Incarcerated femoral hernias and hernias that are operated on openly usually require inpatient treatment. Enemas or laxatives are used to cleanse the bowel on the evening before the femoral hernia operation.
Before the femoral hernia operation, the anesthetist and the surgeon explain the operation and the anesthetic methods to the patient in detail. The surgeon informs the patient about
A femoral hernia operation can be performed open via an abdominal incision or closed (laparoscopically).
Open means that the surgeon makes a long incision directly on the hernia and thus exposes the hernia sac.
Closed femoral hernia surgery does not require a large incision. Instead, the surgeon works inside the body using small instruments and video optics.
With larger hernias, however, simply suturing the hernial orifice can cause tension. This causes pain and can lead to a recurrence of the hernia. For this reason, a plastic mesh is usually used to provide additional stability.
The size of the mesh must significantly overlap the healthy, stable tissue so that it can heal properly. This means that the mesh should always be larger than the actual hernia gap. This ensures a largely tension-free closure of the hernial orifice.
In open femoral hernia surgery, the hernia sac is exposed via an abdominal incision. The surgeon then moves the contents of the hernia sac back into the abdominal cavity and shortens the hernia sac. He then closes the surgical area with a suture.
The hernial orifice is also closed. There are various options for this:
Laparoscopic femoral hernia surgery (minimally invasive) is performed using small incisions of 2-12 mm in length. The surgical instruments and an optical system with a video camera are inserted into the abdominal cavity through these small incisions and the hernia is exposed at its origin.
The surgeon does not make the incisions where the hernia is located, but a good distance away from the hernia region.
This approach through the abdominal wall, also known as laparoscopic femoral hernia surgery, has become increasingly popular. It is less traumatizing (i.e. injures less tissue) and the hospital stay is shorter.
In closed femoral hernia surgery, a synthetic mesh is inserted into the abdominal wall.
Once the contents of the hernia sac have been displaced, the surgeon stretches a polypropylene mesh over the hernial orifice. He attaches it to the abdominal wall from the inside. The mesh is non-absorbable, i.e. it does not dissolve by itself.
The peritoneum is closed over it again. The scar tissue grows into the grid structure of the mesh and creates a new layer. This layer is usually less tense than direct suturing of the skin edges.
There are two main techniques for endoscopic femoral hernia surgery, which are very similar:
In addition to the possible general complications that apply to all operations, such as
swelling in the operating area is possible during femoral hernia operations. This is caused by bruising or accumulation of tissue fluid and usually disappears after a short time.
Mild pain in the surgical area or numbness may also occur after femoral hernia surgery. While the pain soon subsides, numbness in small areas of skin can last longer.
Surgery in close proximity to the bowel, bladder, vessels and nerves always poses a potential risk to these structures. However, injury to large vessels during femoral hernia surgery is extremely rare.
In particular, the blood flow in the large vein that runs through the femoral canal must remain undisturbed. Otherwise there is a risk of thrombosis.
There is also a risk of a femoral hernia recurring in the same place. This risk is present in all femoral hernia surgery procedures. However, it is lower when plastic mesh is used.
Hardening and shrinkage in the area of the plastic mesh used are extremely rare during femoral hernia surgery. Allergies or rejection of the plastic meshes practically never occur.
Depending on the type of anesthesia and the surgical procedure, patients can get up immediately or after a sufficient rest period after femoral hernia surgery. Longer periods of rest are not necessary and are also harmful due to the risk of thrombosis with subsequent embolism.
The first dressing change takes place on the second or third day after the femoral hernia operation. You will be able to shower again after this period.
The stitches are removed on the tenth day after the femoral hernia operation. If self-dissolving suture material was used, removal is not necessary.
Depending on your workload, you will be able to work again two to three weeks after the femoral hernia operation.
Sporting activities should only be resumed three to four weeks after the femoral hernia operation.
Lifting heavy objects weighing more than ten kilograms should be avoided for about two months after femoral hernia surgery.
