Background Information:

What are the other Names for the Procedure?

• Femoral Hernioplasty
• Femoral Herniorrhaphy
• Repair of Femoral Hernia

What is Femoral Hernia Repair surgical procedure?

• Hernia is a protrusion of a piece of tissue or a loop of bowel, through a weak spot or opening in the abdominal wall
• A femoral hernia is a type of hernia that bulges out of a weak spot in the groin region
• A Femoral Hernia Repair or a Femoral Herniorrhaphy is a surgical procedure performed to repair the femoral hernia

What part of the Body does the Procedure involve?

A Femoral Hernia Repair may be performed anywhere in the groin region, or inner aspect of the upper thigh.

Why is the Femoral Hernia Repair surgical procedure Performed?

• A Femoral Hernia Repair procedure is performed, to reduce the patient's risk of a future surgical emergency. If a repair is not performed, the hernia may reduce or become irreducible, obstructed, or strangulated.
• A reducible femoral hernia occurs, when a femoral hernia can be pushed back into the abdomen, either spontaneously or with manipulation. This is the most common type of femoral hernia and is usually a painless condition
• An irreducible femoral hernia occurs, when the hernia becomes stuck in the femoral canal. This can cause pain and a feeling of illness
• An obstructed femoral hernia occurs, when a part of the intestine enters the hernia sac and gets blocked, causing an intestinal obstruction
• A strangulated femoral hernia occurs, when the hernia blocks blood supply to part of the bowel. If the herniated bowel has its blood supply diminished, because of pressure from other nearby organs or structures, the affected tissue can die and be invaded by bacteria. This is a life-threatening surgical emergency condition
• Femoral hernias are more likely to become incarcerated or strangulated, than other hernias, because the affected tissue pushes through a relatively small and closely confined space

What are some Alternative Choices for the Procedure?

All femoral hernias need to be repaired surgically, even if they do not cause any symptoms. The risk of strangulation is high and there is no real alternative choice to surgical repair.

What are the Recent Advances in the Procedure?

Minimally invasive (laparoscopic approach) is a recent advancement in Femoral Hernia Repair.

What is the Cost of performing the Femoral Hernia Repair surgical procedure?

The cost of Femoral Hernia Repair surgical procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Femoral Hernia Repair surgical procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.nlm.nih.gov/medlineplus/ency/article/007399.htm

http://www.surgeryencyclopedia.com/Ce-Fi/Femoral-Hernia-Repair.html

http://www.steinergraphics.com/surgical/003_08.3.html

http://www.laparoscopy.net/inguinal/ingher1.htm

Prior to Femoral Hernia Repair surgical procedure:

How is the Femoral Hernia Repair surgical procedure Performed?

There are two kinds of Femoral Hernia Repair: Open Repair of Femoral Hernia and Laparoscopic Repair of Femoral Hernia

Open Repair of Femoral Hernia:

• An incision is made in the groin
• The femoral hernia sac is identified and separated from the tissues around it
• The sac is then pushed back into the abdomen
• The defect is then obliterated, either by approximation of the adjacent tissue, or by placement of a prosthetic mesh
• In case of an incarcerated femoral hernia, the sac is opened and contents are examined for viability
• In cases of compromised bowels, mesh placement is contraindicated, due to an increased risk of mesh infection

Laparoscopic Repair of Femoral Hernia:

• Using a narrow tube-like instrument (cannula), the surgeon enters the abdomen in the area of the belly button (TAPP - Trans Abdominal Pre-Peritoneal approach), or in-between the two muscle layers of the abdominal wall (TEP - Totally Extra Peritoneal approach)
• A laparoscope (a tiny telescope) connected to a special camera is inserted through the cannula, giving the surgeon a magnified view of the patient's internal organs on a television screen
• Other cannulas are inserted, which allow the surgeon to delicately separate the sac from the adjacent tissues
• Once the sac is separated, the defect is identified and covered with a piece of prosthetic mesh
• Laparoscopic repair is not performed in cases of strangulated hernia, where bowel viability is compromised

Where is the Procedure Performed?

• A Femoral Hernia Repair is usually performed in an out-patient surgery center facility. Normally, the individual can go home, once the procedure is completed
• However, the physician may keep them under overnight observation, if necessary
• In some cases, the patient may be kept under observation for a longer period of time, under advice by the physician
• If the patient is present with an incarcerated or strangulated hernia, the procedure is performed in a hospital. The patient is admitted and discharged after the procedure, as per the instruction of the physician

Who Performs the Procedure?

A Femoral Herniorrhaphy procedure is performed by a physician trained in general surgery, assisted by an anesthesiologist.

How long will the Procedure take?

The time for the Femoral Hernia Repair procedure may take anywhere between 1-2 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine, if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Femoral Hernia Repair procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Femoral Hernia Repair surgical procedure?

• The diagnosis is largely a clinical one, generally done by physical examination of the groin region
• However, in some patients (especially obese patients), imaging in the form of ultrasonography, CT or MRI scans, may aid in the diagnosis
• As females are more prone to this type of hernia, an abdominal x-ray showing small bowel obstruction in a female patient with a painful groin lump, needs no prompt treatment

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Femoral Hernia Repair procedure?
• Why is this procedure necessary? How will this procedure help?
• What does the procedure involve?
• How soon should I get it done? Is there an emergency?
• Who are the medical personnel involved in this procedure?
• What are the risks while performing the procedure?
• What are the possible complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• What are the costs involved?

During the Femoral Hernia Repair surgical procedure:

What kind of Anesthesia is given, during the Procedure?

• General anesthesia (asleep and pain-free) is administered, prior to the Femoral Hernia Repair procedure
• If the hernia is small, the patient may be given local anesthesia and medicine to relax (awake but pain-free)

How much Blood will you lose, during the Procedure?

• Since the procedure requires only a small incision, the amount of blood loss is very little
• If the procedure is under laparoscopic (minimally-invasive) approach, there is little blood loss involved
• If complications arise during the Repair of Femoral Hernia, it could lead to further loss of blood

What are the possible Risks and Complications during the Femoral Hernia Repair surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Repair of Femoral Hernia are:

• Infection
• Bleeding
• Injury to the neighboring structures
• Pain
• Discomfort
• Anesthetic complications
• Need for further procedures
• Pneumonia
• Blood clot formation
• Heart problems

What Post-Operative Care is needed at the Healthcare Facility after the Femoral Hernia Repair surgical procedure?

• At the healthcare facility, generally there is no significant post-procedure care required, unless any complications arise
• In a majority of the cases, the patient is closely monitored in a post-operative room

After the Femoral Hernia Repair surgical procedure:

What are the possible Risks and Complications after the Femoral Hernia Repair surgical procedure?

Post Femoral Hernia Repair procedure, the following complications may arise:

• Excessive bleeding, resulting in blood clot accumulation at the surgery site (hematoma)
• Loss of bowel/bladder function
• Accidental damage to the intestinal tract, other neighboring structures
• Signs of an infection
• Recurrence of the hernia

What is the Prognosis after the Surgery?

• The outcome of an elective Femoral Hernia Repair is usually very good. The recurrence rate is also very low
• Emergency repair carries a greater morbidity and mortality rate; this is directly proportional to the degree of bowel compromise
• Other co-existing medical conditions also influence the outcome

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms following a Femoral Hernia Repair:

• Worsening pain around the surgical wound
• Swelling and redness
• Bleeding or fluid drainage around the spot
• Fever
• Dizziness
• Signs of infection

What Post-Operative Care is needed at Home after the Femoral Hernia Repair surgical procedure?

At home, the following post-operative care is recommended, after a Femoral Hernia Repair procedure:

• For a few hours after the surgery, have a diet consisting only of liquids or semi-solids
• Avoid strenuous physical activities for a certain period of time, before slowly getting back to your regular daily routine
• Keep incision wounds clean and dry
• Complete the prescribed course of medications
• Avoid taking any pain-killers, unless they are prescribed by your physician
• Take stool softeners to prevent constipation, under advice by the physician
• Take antibiotic medication to help combat or prevent infection, under advice by the physician

How long does it normally take to fully recover, from the Procedure?

It may take anywhere between 4-6 weeks, to recover completely from the Femoral Hernia Repair procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision
• The slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Femoral Hernia Repair surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility or hospital
• A general surgeon
• An anesthesiologist (if anesthesia was administered)
• A pathologist

Individuals are advised to inquire and confirm the type of billing, before the Femoral Hernia Repair surgical procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA