Femoral Hernias Are The Third Most Common Hernia
Femoral hernia is a protrusion of the abdominal contents (commonly the intestines) via the femoral canal through a defect in the abdominal wall. It usually presents as a lump in the inner aspect of upper thigh region.
Femoral hernia is the third most common hernia only next to inguinal hernia and incisional hernia and accounts for 17% of all hernias.
Common age group for femoral hernia is 60- 80 years of age. It is rare before 50 years of age and uncommon in children. Females are 10 times more commonly affected than males. Multiparous women are often affected.
Femoral hernia is twice more common in the right side of the groin than in the left side. In 20% of cases it is bilateral.
Chronic cough, smoking, obesity, carrying heavy loads, constipation, benign prostatic hypertrophy are the risk factors for developing a femoral hernia.
Femoral hernia usually presents as a grape like lump in the medial upper thigh region. It can be reducible or irreducible. Reducible femoral hernia disappears on pressing, into the abdominal cavity through the femoral canal. Irreducible femoral hernias do not disappear on pressing and are more prone for complications like obstruction and strangulation.
Strangulation of femoral hernia is a surgical emergency. The strangulated bowel segment loses its blood supply and becomes gangrenous. Any sudden increase in size and excruciating pain with symptoms of nausea and vomiting is highly suspicious of strangulation.
Early diagnosis and treatment is necessary as femoral hernia is most prone for strangulation. Diagnosis is best made by physical examination. Ultrasound and MRI can help in confirming the diagnosis. X-ray can detect obstructions.
Surgical correction is the only modality of treatment for femoral hernia. Using truss for femoral hernia is contraindicated as it can lead to strangulation. Surgery is done under general anesthesia or regional anesthesia. The basic principle of the surgery is to empty the contents of the sac into the abdominal cavity, strengthen the abdominal wall, and close the abdominal wall defect with a mesh.
The 3 surgical approaches for femoral hernia are McEvedy high approach, Lotheissen trans-inguinal approach and Lockwood infra-inguinal approach.
In case of a strangulated femoral hernia the gangrenous segment is removed and the intestines are end to end anastomosed and then rest of the hernia repair is done.
Postoperative outcome for femoral hernia is good. Recurrence rate is less than 3%. Patients with risk factors have a higher incidence of recurrence. So by avoiding the risk factors femoral hernia can be prevented.