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Hernia, femoral repair

 

A hernia is when an internal part of the body, such as an organ, pushes through a weakness in the muscle or surrounding tissue wall. Usually, your muscles are strong and tight enough to keep your intestines and organs in place, but sometimes they are not, causing a hernia.

What is a femoral hernia?

A femoral hernia usually occurs when fatty tissue or a part of your bowel 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, a channel through which blood vessels pass to and from your leg. 

The hernia appears as a painful lump the size of a large grape in the inner upper part of your thigh or groin. The lump can be pushed back in, or disappears when you lie down.

Femoral hernias occur far more frequently in women than men because of the wider shape of the female pelvis. Straining (for example, on the toilet) increases pressure inside the abdomen and can trigger a hernia.

Other triggers include:

  • obesity,
  • a smoker's cough,
  • constipation,
  • carrying or pushing heavy loads, and
  • a growth in the bowel.

Repairing the femoral hernia

A femoral hernia repair is an operation to push the bulge back into place and to strengthen the abdominal wall.

The operation is necessary as a femoral hernia is a potentially dangerous condition:

  • The section of bowel can get stuck in the femoral canal, causing an obstruction. This causes nausea, vomiting and stomach pain, as well as a painful lump in the groin.
  • The section of bowel can get trapped and have its blood supply cut off (known as a strangulated hernia). Emergency surgery within hours is essential to release the trapped tissue and restore its blood supply so it does not die.

Outlook

Femoral hernia repair is a routine operation with very few risks. The hernia will not go away without an operation.

Surgery will get rid of the hernia and prevent you from having any serious complications that a hernia can cause.

After having the operation, you should be able to go home the same day or the day after.

 

There are two ways that a femoral hernia repair can be carried out: open surgery and laparoscopic (keyhole) surgery.

Open surgery

  • The surgeon makes a large (6cm) cut in your lower abdomen or over the hernia.
  • The femoral canal (channel near your bowel) is opened to return the fatty lump or loop of bowel to your abdomen, where it belongs.
  • The canal is closed with stitches to repair the weak spot that let the hernia through.
  • The wall of your abdomen may be strengthened by fixing a patch of nylon mesh to it.
  • If the hernia has become strangulated (trapped) 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.  

Laparoscopic (keyhole) surgery

  • The surgeon makes very small cuts in your abdomen.
  • A specially designed camera and instruments are used to push the fatty lump or loop of bowel back into your abdomen.
  • The hernia is repaired from the inside using a mesh patch in the same way as with open surgery. 

Which operation is for me?

The UK National Institute for Health and Clinical Excellence (NICE), which assesses medical treatments for the NHS, says that both keyhole and open surgery for hernias are safe and work well.

Both types of surgery have advantages and disadvantages (see box). Although keyhole surgery tends to have a quicker recovery time and results in less pain after the operation, the risks of serious complications, such as the surgeon accidentally damaging the bowel, are higher than in open surgery.

The risk of your hernia returning is similar for both operations. You should discuss the advantages and disadvantages of both keyhole surgery and open surgery with your surgeon before deciding on the most appropriate treatment for you.

Your choice will depend on:

  • Whether you can have a general anaesthetic. Elderly people or those in bad health may be too weak or frail to safely receive a general anaesthetic, so may be advised to have open surgery, which can be done under local anaesthetic (where the area is numbed).
  • The experience of your surgeon. Open surgery is more common than keyhole surgery partly because not all surgeons have enough experience in keyhole techniques. According to NICE, a surgeon is inexperienced if they have done the operation fewer than 20 times.

NICE recommends that keyhole surgery should always be considered if the hernia has been repaired previously and comes back (this is known as a recurrent hernia).

Keyhole surgery is especially useful if your surgeon is not sure what type of hernia you have.

Hernia repairs take about 45 minutes. You will usually be able to go home the same day, but some people stay in hospital overnight if they have other medical problems or live alone.

Keyhole surgery vs open surgery

Scars:

  • With keyhole surgery, three cuts are required: one (1.5cm) below the navel and one (0.5cm) either side of the navel.
  • With open surgery, the scar will be in your groin and will be around 5–10cm.

Post-operative pain:

  • With keyhole surgery, there is usually less pain after the operation because the cuts are smaller, there is less muscle damage and the small cuts can be closed with glue.

Recovery time:

  • With keyhole surgery, you can go back to work much earlier than with open surgery.

Complications:

  • The risk of serious complications, such as the surgeon accidentally damaging the bowel, are higher with keyhole surgery.

As with any kind of surgery there are some risks, which differ from person to person. Ask your surgeon to explain how these could apply to you before your operation.

Around one in 100 femoral hernias will return after the operation.

Specific complications

Complications that are specific to this operation 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, and
  • injury to the nerves, causing pain or numbness in the groin area.

These complications are rare.

General complications

Possible complications of any operation include:

  • pain,
  • bleeding,
  • infection in the surgical wound,
  • ugly scarring, and
  • blood clots.

You will not feel any pain while your hernia is being repaired, but your groin will feel sore and uncomfortable afterwards. You will be given painkillers to help relieve this discomfort.

You should be able to go home the same day or the day after your operation. Get an adult to take you home in a car or taxi.

Looking after yourself

An adult must stay with you for the first 24 hours after your operation.

You can follow these tips to ensure your recovery is as quick as possible.

  • Follow the instructions your nurse gave you about caring for your wound, hygiene and bathing.
  • If you are still in pain, continue taking painkillers as advised by the hospital.
  • Eat plenty of vegetables, fruit and high-fibre foods such as brown rice, wholemeal bread and pasta. This helps to avoid constipation, which may cause pain in your wounds from straining.
  • In general, take it easy for the first two or three days.

Activities

A general anaesthetic (which puts you to sleep during your operation) can affect your coordination and reasoning skills, so avoid alcohol, operating machinery or signing legal documents for at least 48 hours.

You cannot drive legally within 48 hours of a general anaesthetic. It will be at least one to two weeks before you can drive after keyhole surgery and two to six weeks after open surgery. You must not drive before you are pain free. Contact your car insurance company before returning to the wheel.

It usually takes 10-15 days before you can get back to normal activities such as walking, shopping and sport. You may recover faster if you have had keyhole surgery.

You should be able to return to work after two to four weeks, depending on the extent of surgery and your type of work.

Gentle exercise can help the healing process, but you should avoid anything too strenuous and heavy lifting.

You may find sex painful or uncomfortable at first, but it is fine to have sex when you feel like it.

When to call a doctor

Call your GP or surgeon if you develop any of the following symptoms:

  • persistent fever over 39°C (102°F),
  • bleeding,
  • increased swelling or pain of your abdomen,
  • pain that is not relieved by your medications,
  • persistent nausea or vomiting,
  • chills,
  • persistent coughing or shortness of breath, or
  • increasing redness surrounding your incisions.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.