Femoral hernia repair
Femorocele repair; Herniorrhaphy; Hernioplasty - femoral
Femoral hernia repair is surgery to repair a hernia near the groin in the upper thigh. A femoral hernia is tissue that bulges out of a weak spot in the groin. Usually, this tissue is part of the intestine.
Description
During surgery to repair the hernia, the bulging tissue is pushed back in. The weakened area is sewn closed or strengthened. This repair can be done with open or laparoscopic surgery. You and your surgeon can discuss which type of surgery is right for you.
In open surgery:
- You may receive general anesthesia. This is medicine that keeps you asleep and pain-free. Or, you may receive regional anesthesia, which numbs you from the waist to your feet. Or, your surgeon may choose to give you local anesthesia and medicine to relax you.
- Your surgeon makes a cut (incision) in your groin area.
- The hernia is located and separated from the tissues around it. Some of the extra hernia tissue may be removed. The rest of the hernia contents are gently pushed back inside your abdomen.
- The surgeon then closes your weakened abdominal muscles with stitches.
- Often a piece of mesh is also sewn into place to strengthen your abdominal wall. This repairs the weakness in the wall.
- At the end of the repair, the cuts are stitched closed.
In laparoscopic surgery:
- The surgeon makes 3 to 5 small cuts in your groin and lower belly.
- A medical device called a laparoscope is inserted through one of the cuts. The scope is a thin, lighted tube with a camera on the end. It lets the surgeon see inside your belly.
- Gas is pumped into your belly to expand the space. This gives the surgeon more room to see and work.
- Other tools are inserted through the other cuts. The surgeon uses these tools to repair the hernia.
- The same repair will be done as in open surgery.
- At the end of the repair, the scope and other tools are removed. The cuts are stitched closed.
Why the Procedure Is Performed
Unlike an inguinal hernia, a femoral hernia should be repaired, even if it does not cause symptoms. If the hernia is not repaired, the intestine can get trapped inside the hernia. This is called an incarcerated, or strangulated, hernia. It can cut off blood supply to the intestines. This can be life threatening. If this happens, you would need emergency surgery.
You're lifting a heavy box, when suddenly, you feel a strain in your stomach or groin. If you also feel a bulge there, you might have a hernia. The bump that you feel is a part of what's in your abdomen bulging out through a weak spot in the muscle or tissue that surrounds it. A hernia is kind of like pushing your finger against the side of a balloon. What type of hernia you have depends on where the bulge is located. A femoral hernia is a bulge in the upper part of your thigh. A hiatal hernia is located in the top part of your stomach. An umbilical hernia bulges around your belly button. Inguinal hernias are in the groin area. And incisional hernias usually form around a scar from a past surgery in your abdomen. You can get a hernia if you lift something that's too heavy, or strain too hard while coughing, urinating, or having a bowel movement. Sometimes babies are born with a hernia. That happens when the lining that is supposed to hold the abdominal organs doesn't totally close before birth. Some hernias don't cause any symptoms. You might live with a hernia for a while without even noticing that you have it. Or, you may see an actual bulge in your leg, stomach, or groin. Hernias can sometimes be painful, especially when you strain or lift something heavy. Your doctor should be able to locate the hernia during an exam. If your hernia is small and doesn't bother you, you may not need to do anything but keep in touch with your doctor to make sure it isn't growing. If the hernia is big or painful, your doctor may recommend surgery to plug the opening. The one big risk to having a hernia is that with some types the tissue can get caught inside the hole. This is called strangulation. It can be very dangerous, because blood is cut off to the part of the organ that's trapped. Eventually that tissue will die. If you have a strangulated hernia, you'll need to have emergency surgery. Surgery is the only way to reverse a hernia, although in young children umbilical hernias will often go away on their own. If you have a small hernia and decide not to have surgery, be on the lookout for any changes. Call the doctor right away if you have pain, nausea, vomiting, or a fever, or if your hernia turns red, purple, or another color. These could be signs of strangulation. To avoid a hernia in the first place, be careful when lifting heavy objects. Drink plenty of fluids and add fiber to your diet so you won't have to push too hard on the toilet. And see a urologist if you're straining while urinating.
Risks
Risks for anesthesia and surgery in general are:
- Reactions to medicines
- Breathing problems
- Bleeding, blood clots, or infection
Risks for this surgery are:
- Damage to blood vessels that go to the leg
- Damage to the nearby nerve
- Damage near the reproductive organs, for women
- Long-term pain
- Return of the hernia
Before the Procedure
Tell your surgeon or nurse if:
- You are or could be pregnant
- You are taking any medicines, including drugs, supplements, or herbs you bought without a prescription
During the week before your surgery:
- You may be asked to temporarily stop taking blood thinners. These include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), warfarin (Coumadin, Jantoven), naproxen (Aleve, Naprosyn), and others.
- Ask your surgeon which medicines you should still take on the day of surgery.
On the day of surgery:
- Follow instructions about when to stop eating and drinking.
- Take the medicines your surgeon told you to take with a small sip of water.
- Arrive at the hospital on time.
After the Procedure
Most people can go home on the same day as the surgery. Some need to stay in the hospital overnight. If your surgery was done as an emergency, you may need to stay in the hospital a few days longer.
After surgery, you may have some swelling, bruising, or soreness around the incisions. Taking pain medicines and moving carefully can help.
Follow instructions about how active you can be while recovering. This may include:
- Returning to light activities soon after going home, but avoiding strenuous activities and heavy lifting for a few weeks.
- Avoiding activities that can increase pressure in the groin area. Move slowly from a lying to a seated position.
- Drinking plenty of fluids and eating lots of fiber to prevent constipation.
Outlook (Prognosis)
Outcome of this surgery is often very good. In some people, the hernia returns.
References
Dunbar KB, Jeyarajah DR. Abdominal hernias and gastric volvulus. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 27.
Poulose BK, Carbonell AM, Rosen MJ. Hernias. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. Philadelphia, PA: Elsevier; 2022:chap 45.
Version Info
Last reviewed on: 3/11/2023
Reviewed by: Debra G. Wechter, MD, FACS, General Surgery Practice Specializing in Breast Cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
