Overview

A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall.

Your muscles are usually strong and tight enough to keep your intestines and organs in place, but a hernia can develop if there are any weak spots.

What is a femoral hernia?

A femoral hernia is an uncommon type of hernia.

Femoral hernias sometimes appear as a painful lump in the inner upper part of the thigh or groin. The lump can often be pushed back in or disappears when you lie down. Coughing or straining may make the lump appear.

For information on other types of hernia, see:

• inguinal hernia
• hiatus hernia
• umbilical hernia

What causes a femoral hernia?

A femoral hernia usually occurs when fatty tissue or a part of your bowel pokes through into your groin at the top of your inner thigh.

It pushes through a weak spot in the surrounding muscle wall (abdominal wall) into an area called the femoral canal.

Unlike inguinal hernias, femoral hernias occur far more frequently in women, particularly older women. This is because of the wider shape of the female pelvis. Femoral hernias are rare in children.

Femoral hernias can sometimes appear suddenly because of strain on the tummy, such as:

• straining on the toilet if you have constipation
• carrying and pushing heavy loads

They've also been linked to obesity and having a persistent, heavy cough.

When is surgery needed?

Femoral hernias can be repaired using surgery to push the bulge back into place and strengthen the weakness in the wall of the tummy.

Unlike some other types of hernia, treatment of femoral hernias is almost always recommended straight away because there's a higher risk of complications developing in these cases.

Complications that can develop as a result of a femoral hernia include:

• obstruction – where a section of the bowel becomes stuck in the femoral canal, causing nausea, vomiting and stomach pain, as well as a painful lump in the groin
• strangulation – where a section of bowel becomes trapped and its blood supply is cut off; this requires emergency surgery within hours to release the trapped tissue and restore its blood supply, so it doesn't die

Surgery gets rid of the hernia and prevents any serious complications, although there's a chance of it returning after the operation.

What happens during surgery?

There are two ways a femoral hernia repair can be performed:

• open surgery – where a cut is made to allow the surgeon to push the lump back into your tummy
• laparoscopy (keyhole) surgery – a less invasive, but more difficult, technique where several smaller cuts are made, allowing the surgeon to use various special instruments to repair the hernia

There are advantages and disadvantages to both methods. The type of surgery you have depends on which method suits you and your surgeon’s experience.

You should be able to go home the same day or the day after surgery. It's important to follow the hospital's instructions on how to look after yourself. This includes eating a good diet to avoid constipation, caring for the wound and not straining yourself too soon.

Most people make a full recovery from femoral hernia repair within six weeks, although many people can return to driving, work and light activities within two weeks.

Are there any risks from the operation?

Femoral hernia repair is a routine operation with very few risks, although in a small number of cases, the hernia returns after the operation.

Other uncommon complications of femoral hernia repair include:

• developing a lump under the wound
• difficulty passing urine
• injury or narrowing of the femoral vein (which passes through the femoral canal)
• injury to the bowel
• temporary weakness of the leg
• injury to the nerves, causing pain or numbness in the groin area

Complications are more likely in older people or those with other conditions.

How is it performed?

A femoral hernia repair can be carried out as either open surgery or keyhole surgery (also called laparoscopic surgery).

The hospital will send instructions about when you need to stop eating and drinking before the operation.

Femoral hernia repair is usually carried out under general anaesthetic, which means you'll be asleep during the procedure and won't feel any pain.

However, regional or local anaesthetic is sometimes used for open surgery. This means you'll be awake during the procedure, but the area being operated on will be numbed, so you won't experience any pain.

The operation should take about 30-45 minutes to complete and you'll usually be able to go home the same day. Some people stay in hospital overnight if they have other medical problems or if they live alone.

Open surgery

During open surgery to repair a femoral hernia, the surgeon makes a single cut (incision) in your lower tummy or over the hernia. This incision is usually about 3-4cm long.

The femoral canal (a channel containing the main blood vessels and nerves leading to the thigh) is opened and the surgeon places the lump of fatty tissue or loop of bowel back into your tummy.

The femoral canal is then closed, often with a mesh plug, to repair the weak spot that let the hernia through.

The incision in your skin is then sealed with stitches. These usually dissolve on their own over the course of a few days after the operation.

If the hernia has become trapped (strangulated) and part of the bowel damaged, the affected segment may need to be removed and the ends of healthy bowel rejoined. This is a bigger operation and you may need to stay in hospital for a few days.

Laparoscopic (keyhole) surgery

During keyhole surgery to repair a femoral hernia, several very small incisions are usually made instead of a single, larger incision.

A thin tube containing a light and a camera (laparoscope) is inserted through 1 of the incisions, so the surgeon can see inside your tummy.

Special surgical instruments are inserted through the other incisions, so the surgeon can pull the hernia back into place. As with open surgery, a mesh patch is often used to strengthen the weak spot in the tummy where the hernia came through.

Once the repair is complete, the incisions in your skin are sealed with stitches or surgical glue.

Which technique is best?

The National Institute for Health and Care Excellence (NICE), which assesses medical treatments for the NHS, says that both keyhole and open surgery for hernias are safe and work well.

With keyhole surgery, there's usually less pain after the operation because the cuts are smaller.

However, the risks of serious complications, such as the surgeon accidentally damaging the bowel, can be higher in keyhole surgery.

The risk of your hernia returning is similar for both operations.

Discuss the advantages and disadvantages of keyhole surgery and open surgery with your surgeon before deciding on the most appropriate treatment.

Deciding which technique to use

The choice of technique for femoral hernia repair largely depends on:

• your general health – elderly people or people in bad health may be too weak or frail to safely have a general anaesthetic, so open surgery under local anaesthetic may be advised
• the experience of your surgeon –open surgery is more common than keyhole surgery, so not all surgeons have enough experience in keyhole techniques

Keyhole surgery can be useful if your surgeon isn't sure exactly what type of hernia you have.

Recovery

You should be able to go home on the day of, or the day after, your operation. Get an adult to take you home in a car or taxi and follow any instructions you're given by the hospital.

After the operation, your groin will feel sore and uncomfortable. You'll be given painkillers to help relieve this discomfort.

Looking after yourself

An adult must stay with you for the first 24 hours after your operation, in case you experience any problems.

If you're still in pain after going home, continue taking painkillers as advised by the hospital. Applying gentle pressure to your wound using your hand or a small pillow can make coughing, sneezing and moving between sitting and standing more comfortable.

Make sure you follow the instructions your nurse gave you about caring for your wound, hygiene and bathing.

Straining on the toilet because of constipation can cause pain around your wound. You can reduce your risk of constipation by drinking lots of fluids and eating plenty of vegetables, fruit and high-fibre foods, such as brown rice, wholemeal bread and pasta. A mild, over-the-counter laxative may also help.

Activities

If the operation was carried out under a general anaesthetic (which puts you to sleep during your operation), your co-ordination and reasoning may be affected for a short time. Avoid drinking alcohol, operating machinery or signing legal documents for 24 to 48 hours after any operation involving general anaesthetic.

Over time, you can gradually return to your normal activities as soon as you're able to do them without feeling any pain.

Most people are able to do light activities, such as shopping, after one or two weeks. You should also be able to return to work after two or three weeks, although you may need more time off if your job involves manual labour.

Gentle exercise, such as walking, can help the healing process, but you should avoid heavy lifting and strenuous activities for about four to six weeks.

You may find sex painful or uncomfortable at first, but it's usually fine to have sex when you feel like it.

Driving

Speak to the medical professional in charge of your care for advice about when you can drive. It's usually advisable to avoid driving until you are able to perform an emergency stop without feeling any pain or discomfort (you can practise this without starting your car).

It will usually be one or two weeks before you reach this point after having keyhole surgery, although it may take longer after open surgery.

It's usually recommended that you contact your car insurance company before starting driving again.

When to call a doctor

Call your surgeon if you develop any of the following symptoms:

• persistent fever 
• persistent or heavy bleeding
• increased swelling or pain in your tummy
• pain that is not relieved by painkillers
• persistent nausea or vomiting
• chills
• persistent coughing or shortness of breath
• increasing redness surrounding your incisions
• difficulty passing urine