Femoral hernias occur in the groin – the small area of the lower abdomen on each side, just above the line separating the abdomen and the legs.
They are relatively uncommon (they account for 2% of all hernias and 6% of all groin hernias, the other 94% are inguinal), more likely to occur in women than in men (70% of femoral hernias occur in women, probably because of their wider pelvis making the femoral canal slightly larger) and are often confused with inguinal hernias by both patients and doctors.
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.
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 requires immediate, emergency surgery. The estimated time for bowel viability (survival) is about 8-12 hours.
Why is strangulation common?
The reason so many femoral hernias come to light as emergencies is probably that the femoral canal, through which the hernia appears, is narrow with most of its entrance (the femoral ring) rigid and unyielding.
What should I do?
Femoral hernias should be repaired early and not left until they become a problem. Not all doctors realise how important this is.
ALL femoral hernias in women of any age should be seen by an expert urgently as the risks attached to this kind of case while untreated are significant.
What operation?
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, trying to sew two rigid structures to each other. The result can be both painful and not very reliable.
Our preferred method is 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 anaesthesia through a short cosmetically-placed incision just above the groin crease.
The success rate will depend on who does the operation.
See also: Methods of Repair later in this site