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A hernia is when an internal part of the body, such as an organ, pushes through a weakness in the muscle or surrounding tissue wall. Usually, your muscles are strong and tight enough to keep your intestines and organs in place, but sometimes they arenít, causing a hernia.
A femoral hernia occurs when tissue pokes through into your groin or the top of your inner thigh. It pushes through a weak spot in the abdominal wall called the femoral canal.
The abdominal wall is a sheet of tough muscle and tendon that runs between your ribs and your groin (upper part of your leg). Your abdominal wall acts like a natural corset holding all the abdominal contents of your body in place. There are natural weaknesses in the abdominal wall, such as where the blood vessels and nerves pass through. One of these weak areas is along the femoral canal which is in the groin.
A hernia is a weakness in the muscles which form the front of the body wall. Usually, the bowel or some fat, and more rarely other organs, can push through this weak spot and create a bulge in the area. In your case the hernia is just below your groin. It is usually caused by the body wall being weak from birth. Sometimes the body wall weakens with the passing of time. Sometimes the body is overstrained by coughing, heavy work or sport etc. Hernias are very common and are easily treated. If left untreated they get bigger and cause pain. More dangerously, the bowel can sometimes get trapped in the weak spot of the muscles. This can cause a blockage of the bowel, which can eventually cause it to become strangulated. An emergency operation is then required to deal with the problem.
Sometimes this weakness in your muscle or body tissue opens up so whatever is on the inside can push through the area of weakness. This causes a bulge or swelling called a hernia.
A hernia occurs when abdominal contents, usually part of the small intestine, push through a weak point or tear in the thin muscular wall of the abdomen that holds the abdominal organs in place.
In a femoral hernia, a bulge is usually present in the upper part of the thigh, just below the groin, where the femoral artery and vein pass. Femoral hernias tend to occur more often in women than in men.
Femoral hernias occur far more frequently in women than men because of the wider shape of the female pelvis. Straining, which increases pressure inside the abdomen, can trigger a hernia. Other triggers include:
- A smokerís cough
- Carrying or pushing heavy loads
How does a hernia occur?
Hernias can occur from a defect at birth or from gradual weakening of the tissue. The abdominal wall muscles surround the stomach, intestines, and other organs. There is an opening in the groin on each side called the femoral canal. This opening is beside the large (femoral) vein draining blood from the leg. The space of the femoral canal allows the vein to expand to drain the blood from the leg when you are exercising or walking. The canal is larger in women than in men. Coughing, straining and pregnancy can cause weak spots in the femoral canal. This can result in the contents of the abdomen being pushed through the abdominal wall. When fat or bowel protrudes into this canal, it produces a lump called a hernia.
How keyhole femoral hernia surgery is carried out?
If your hernia is small your doctor may use a local anaesthetic. You will be awake throughout the operation but the skin and nerves around the hernia will be completely numb, though you may feel some pulling and pushing. There will be a screen above your groin so you won't be able to see the operation on your body.
One of the reasons a local anaesthetic is used for operations is that patients tend to recover more quickly afterwards. Also, for most patients it may be safer than a general anaesthetic. Sometimes a sedative is given to help you relax during the operation. This is not the same as a general anaesthetic.
If you have had a sedative the effects may last longer than you expect. Don't drive, drink alcohol, operate machinery or sign legal documents until your doctor tells you that it is safe. This will be at least 24 hours after your operation.
Some hernia operations mean that you will need a general anaesthetic, where you are put to sleep completely for the whole operation. General anaesthetic is used in some circumstances, for example, if the hernia is large or for keyhole repairs.
General anaesthesia can temporarily affect your co-ordination and reasoning skills, so you should not drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards.
A femoral hernia is usually diagnosed during a physical examination. In many cases, the patient will consult the doctor because of pain in the groin area or the inside of the upper thigh. The pain or discomfort of a femoral hernia may come and go, increasing when the person coughs or strains. If the pain is severe, the patient may go to an emergency room. In young children, symptoms of an incarcerated femoral hernia include severe irritability, abdominal pain, cramping, and vomiting. Adult patients may have also felt a mass in the groin that may be tender when it is pressed. Patients in severe pain may be given a sedative or pain-killing medication so that the doctor can examine the groin area and try to guide the herniated tissues back through the abdominal opening with gentle manual pressure.
In adult patients, the doctor will rule out the possibility that the pain is caused by an enlarged lymph node, a lipoma, or an inguinal hernia. Imaging studies are not generally used in diagnosing a hernia unless the doctor suspects that the hernia is incarcerated or strangulated. A strangulated hernia can be distinguished from an incarcerated hernia by the presence of fever; pain that persists after the doctor has reduced the hernia manually; and pain that is more severe than warranted by the examination findings.
All surgical procedures have associated risks, both surgical and anesthesia-related. Bleeding and infection are the two primary surgical risks. The risk of infection for an uncomplicated femoral hernia repair is about 1%. Anesthesia-related risks include reactions to the anesthetic agents, including interactions with over-the-counter and herbal preparations, as well as potential respiratory problems. There is a small risk of recurrence of a femoral hernia. In addition, female patients are at some risk of injury to the nerves and blood supply of their reproductive organs, because femoral hernias develop in a part of the abdominal wall that is close to the uterus and ovaries.
- General complications of any operation
- Infection in the surgical wound
- Unsightly scarring
- Blood clots
- Specific complications of this operation
- Developing a lump under the wound
- Difficulty passing urine
- Injury or narrowing of the femoral vein
- Injury to structures within the hernia
- Temporary weakness of the leg
Femoral hernias are more common in women, usually elderly and frail (although they can happen in children). They typically present as a groin lump. They may or may not be associated with pain. Often, they present with a varying degree of complication ranging from irreducibility through intestinal obstruction to frank gangrene of contained bowel. The incidence of strangulation in femoral hernias is high. A femoral hernia has often been found to be the cause of unexplained small bowel obstruction.
The obvious finding may be a lump in the groin. Cough impulse is often absent and should not be relied on solely when making a diagnosis of femoral hernia. The lump is more globular than the pear shaped lump of the inguinal hernia. The bulk of a femoral hernia lies below an imaginary line drawn between the anterior superior iliac spine and the pubic tubercle (which essentially represents the inguinal ligament) whereas an inguinal hernia starts above this line. Nonetheless, it is often impossible to distinguish the two preoperatively.
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