Femoral Hernia

Approach

  • Expose patient as for inguinal hernia examination
  1. Inspect
    • Marble shaped lump in the groin
    • May be scar from previous surgery
  2. Palpate
    • Demonstrate inguinal ligament
    • Femoral herniae are found below inguinal ligament (inguinal arise above)
    • Ask patient ot cough - femoral herniae tend to not have a cough impulse
    • Ask patient if lump is reducible
    • Describe lump
  3. Percuss
  4. Auscultate

Completion

  1. Examine contralateral groin for herniae

 

Differentiating from inguinal hernia

Inguinal hernia Femoral hernia
Above inguinal ligament Below inguinal ligament
Usually reducible Usually irreducible
M:F 6:1 M:F1:
Risk of strangulation low Risk of strangulation high
Cough impulse present Cough impulse usually absent

 

Differential diagnosis

  1. Skin and soft tissue masses
    • Sebaceous cyst
    • Lipoma
    • Sarcoma
  2. Vascular masses
    • Saphena varix
    • Femoral aneurysm
    • Inguinal lymphadenopathy
  3. Other herniae
    • Inguinal hernia
    • Obturator hernia
  4. Others
    • Psoas bursa
    • Ectopic testis

Surgical options

  1. Reduction of contents of sac
  2. Excision of sac
  3. Repair of defect

  1. Crural / low approach: best option for elective but risk of narrowing femoral vein when closing femoral canal
    • Incision made over hernia
    • Sac ligated and femoral canal closed with non-absorbable sutures
  2. Abdominal / preperitoneal approach (McEvedy): best technique for strangulated hernia as can be easily converted to more extensive operation seeking any ischaemic bowel withouth making a second incision
    • Pfannensteil / lower midline incision used to repair bilateral hernia
    • Femoral canal closed without breeching peritoneum
  3. Inguinal or high repair
    • Posterior wall of inguinal canal is opened to access femoral canal from above
    • Best approach if nature of hernia is uncertain as inguinal hernias can also be repaired
    • Recurrent inguinal hernias are