Femoral hernias occur in the groin. They are uncommon, are more likely to occur in women than men and are often confused with inguinal hernias, by both patients and doctors (!).
Here are some statistics :-
Uncommon – they account for 2% of all hernias and 6% of all groin hernias (the other 94% are inguinal).
Slightly commoner in women – 70% of femoral hernias occur in women, probably because of their wider pelvis making the femoral canal lightly larger.
Emergencies – almost half of all femoral hernias first come to light as emergencies.
What would I see? – A small swelling very low down next to the groin skin crease; sometimes just below the crease so the swelling seems to be at the top of the thigh.
Where exactly do they come out? – understanding the anatomy of femoral hernias <See more>
What would I feel? – Often very little, perhaps a bit of an ache. This is why they tend to be so ‘dangerous’ – there are often no symptoms until they strangulate. If strangulation occurs the lump becomes hard and tender. A femoral hernia that gets stuck or incarcerated, on the way to strangulation, can cause severe local and abdominal pain, nausea, and vomiting. If a loop or ‘knuckle’ of intestine is within the hernia sac it requiring immediate emergency surgery. The estimated time for bowel viability (survival) is about 8 -12 hours.
Why is strangulation common?
It has been estimated that about 50% of femoral hernias first come to light as emergencies. The reason is probably that the femoral canal, through which the hernia appears, is narrow with most of its entrance (the femoral ring) rigid and unyielding. (See anatomy of femoral hernias ) So if a ‘knuckle’ of intestine enters it becomes trapped easily. It is easier to understand with a picture or diagram.
What should I do?
Femoral hernias should be repaired early and not left until they become a problem. Not all doctors realize how important this is.
The goal of surgery is to close off the femoral canal. Before ‘mesh’ arrived on the scene this was done with stitches – stitching the front and back of the opening together. The problem is that there is not much give here – you are trying to sew two rigid structures to each other. Painful and not very reliable. (See anatomy of femoral hernias)
Suture. This is probably still the standard method, certainly in the UK. There is quite a lot of pain and the recurrence rate can be high, but accurate or reliable figures are just not available. Check the Scandinanvian databases.
Mesh cone or plug. I prefer to place a soft mesh cone plug in the femoral canal. This sits in the femoral canal where it remains, stopping anything going through. This can be done with local anesthetic through a short cosmetically placed incision just above the groin crease.
‘Keyhole’. The procedure can also be performed laparoscopically, covering the entrance to the femoral canal with mesh. The success rate will depend on who does the operation.