Makindo Medical Notes.com

Because of the high incidence of complications, femoral hernias often need emergency surgery.

About

• A femoral Hernia is a weakness in the abdominal wall
• This allows abdominal contents to enter Herniated material may just be peritoneum and fat but can be small bowel.
• Strangulation can occur due to the narrow "necks".

Risks

• Can occur in both males and females
• Women> males x 10
• Due to wider bone structure of the female pelvis.
• Obesity, Heavy lifting, Coughing
• Straining with urination or defecation
• COPD, Ascites

Types

• Herniated material can be pushed back : reducible hernia
• Herniated material may not be able to be pushed back : non reducible or incarcerated hernia
• Bowel can become trapped and cause obstruction.
• Bowel can have its vascular supply compromised and be strangulated
• These are acute surgical emergencies

Clinical

• Swelling lies below inguinal ligament
• Emerges below and lateral to the pubic tubercle
• Tenderness suggests possible strangulation
• Most femoral hernias cause no symptoms.
• Groin discomfort may worsen when standing, lifting heavy objects, or straining.
• Abdominal pain, nausea, and vomiting suggests complications

Investigations

• Ultrasonography, CT or MRI may aid in the diagnosis.

Pathology

Management

• Acute Presentation - ABC, IV fluids, Nil by Mouth, Analgesia, Fluid Resuscitation if pain or incarcerated/strangulated/obstructed needs urgent surgical review. May need IV antibiotics. The strangulated bowel can result in necrosis and gangrene.
• Delayed treatment may be fatal. Some may need laparotomy and resection of the large or small bowel. Others may require a period of conservative assessment if not obstructed.

Open Hernia Repair

• Open hernia repair (herniorrhaphy) can be done under local anaesthesia. An incision is made.
• The surgeon reduces the hernia and repair is either performed by suturing the inguinal ligament to the pectineal ligament using strong non-absorbable sutures or by placing a mesh plug in the femoral ring.

Laparoscopic Femoral Hernia Repair

• Laparoscopic surgery is done under general anaesthesia. The surgeon makes several small incisions in the lower abdomen and inserts a laparoscope.
• The surgeon carefully repairs the hernia using synthetic mesh.
• Open surgery performed if the hernia is very large or the person has had pelvic surgery.

Potential Complications

• Risk of general anaesthesia. Common complications include nausea, vomiting, urinary retention, sore throat, and headache. More serious problems include MI, stroke, pneumonia, and blood clots in the legs.
• DVT/PE: Follow local policies. Getting out of bed after surgery and moving as soon as the doctor allows will help reduce the risk of complications such as pneumonia and blood clots.
• Hernia recurrence. A hernia can recur up to several years after repair. Recurrence is the most common complication of inguinal hernia repair, causing patients to undergo a second operation.
• Bleeding. Bleeding inside the incision is another complication of inguinal hernia repair. It can cause severe swelling and bluish discolouration of the skin around the incision. Surgery may be necessary to open the incision and stop the bleeding. Bleeding is unusual and occurs in less than 2 per cent of patients.
• Wound infection. The risk of wound infection is small-less than 2 per cent. The person may experience a fever, discharge from the incision, and redness, swelling, or tenderness around the incision. Postoperative infection requires antibiotics and a senior review.
• Painful scar. Sometimes people experience sharp, tingling pain in a specific area near the incision after it has healed. The pain usually resolves with time. Local anaesthetics may be injected in the area if the pain continues.
• Injury to internal organs. Although extremely rare, injury to the intestine, bladder, kidneys, nerves and blood vessels leading to the legs, internal female organs, and vas deferens-the tube that carries sperm-can occur during hernia surgery and may lead to more operations.

References