Makindo Medical Notes

Due to a high incidence of complications, femoral hernias often require emergency surgery.

About

• A femoral hernia occurs when abdominal contents push through a weakness in the abdominal wall and enter the femoral canal.
• Contents may include peritoneum, fat, or small bowel, with a high risk of strangulation due to the narrow neck of the femoral canal.

Risk Factors

• Females are 10 times more likely than males to develop a femoral hernia, largely due to the wider structure of the female pelvis.
• Additional risk factors include obesity, heavy lifting, chronic coughing, straining with urination or defecation, COPD, and ascites.

Types of Femoral Hernias

• Reducible: Herniated material can be pushed back into the abdominal cavity.
• Non-reducible (Incarcerated): Herniated material cannot be pushed back, potentially causing obstruction.
• Strangulated: Blood supply to the bowel is compromised, leading to ischaemia. This is a surgical emergency.

Clinical Presentation

• Swelling lies below the inguinal ligament, appearing below and lateral to the pubic tubercle.
• Most femoral hernias are asymptomatic, though tenderness may indicate strangulation.
• Groin discomfort may worsen with standing, lifting, or straining.
• Abdominal pain, nausea, and vomiting suggest complications and warrant urgent evaluation.

Investigations

• Ultrasonography, CT, or MRI can aid in diagnosing femoral hernias and evaluating complications.

Management

• Acute Presentation: Supportive care (ABCs, IV fluids, analgesia, Nil by Mouth) with urgent surgical review for signs of incarceration or strangulation. Strangulated hernias may require IV antibiotics to prevent necrosis and gangrene.
• Delayed Treatment: Severe cases may necessitate laparotomy with bowel resection, while conservative observation may suffice for non-obstructed hernias.

Open Hernia Repair

• Performed under local anaesthesia via an incision in the groin.
• Involves reducing the hernia and securing the inguinal ligament to the pectineal ligament with non-absorbable sutures or mesh placement.

Laparoscopic Femoral Hernia Repair

• Performed under general anaesthesia with several small abdominal incisions.
• The hernia is repaired with synthetic mesh, offering a minimally invasive approach and shorter recovery time.
• Open surgery may be preferred for very large hernias or in patients with previous pelvic surgeries.

Potential Complications

• General Anaesthesia Risks: Common issues include nausea, vomiting, urinary retention, sore throat, and headache, with more serious risks like MI, stroke, pneumonia, and blood clots.
• DVT/PE: Early mobilization post-surgery helps reduce the risk of blood clots and pneumonia.
• Hernia Recurrence: A potential complication that may necessitate additional surgery.
• Bleeding: Can lead to swelling and bruising; severe cases may require surgical intervention.
• Wound Infection: Occurs in less than 2% of cases; may require antibiotics and additional care if symptoms arise.
• Painful Scar: Some experience tingling or pain near the incision, which usually resolves but may need local anaesthetic treatment if persistent.
• Injury to Internal Organs: Rare, but accidental injury to organs like the intestine, bladder, or blood vessels may occur, possibly requiring further surgical management.

References

• Anatomy of Femoral Hernias - Kenhub