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Script for Femoral Hernia Podcast
Host: Hello and welcome to our Surgical Educator podcast. I am your host/ master of ceremony for today’s episode. We are going to discuss the surgical problem Groin swellings in the forthcoming weeks. Last week we discussed the commonest cause for the groin swellings-the Inguinal hernia. Today in this episode we are going to discuss one of the causes for the groin swellings- the femoral hernia. In this episode, we will be discussing the epidemiology, etiology, applied surgical anatomy pathology, clinical features, differential diagnosis, treatment, and post-op complications of femoral hernia. Our expert Surgeon Prof Dr Selvaraj is here to answer all our questions. So, let's dive deep into the topic.
Q1. What is a femoral hernia doctor?
Answer: A femoral hernia is a type of hernia where abdominal contents protrude through the femoral canal, a small space located just below the inguinal ligament in the groin area. Femoral hernias are more common in women than in men and account for approximately 3% of all abdominal hernias. But even in females the commonest hernia is inguinal hernia.
Q2; What is the epidemiology of femoral hernia?
Answer: Femoral hernias are more common in women than men, with a female-to-male ratio of approximately 3:1. They typically occur in women over the age of 50 and in men over the age of 40. Right side is more affected than the left. It is bilateral in 15 to 20 percent cases. It is the third most common type of hernia after inguinal and incisional hernias.
Q 3: What are the different causes for groin swellings?
Answer: The commonest cause is Inguinal hernia. Other causes are Femoral hernia, inguinal lymphadenitis, encysted hydrocele, lipoma of the cord, undescended testis, saphena varix, femoral artery aneurysm, femoral nerve neuroma and psoas abscess.
Q 4: What applied surgical anatomy a medical student should know about femoral hernia?
Answer: The femoral canal is the medial compartment of the femoral sheath, an inverted cone-shaped fascial space medial to the common femoral vein within the upper femoral triangle. It is only 1-2 cm long and opens superiorly as the femoral ring.
The opening to the femoral canal is located at its superior border, known as the femoral ring. The femoral ring is closed by a connective tissue layer – the femoral septum. This septum is pierced by the lymphatic vessels exiting the femoral canal. Femoral ring is bounded anteriorly by inguinal ligament, posteriorly by pectineal ligament, medially by lacunar ligament and laterally by femoral vein.
Q 5: What is the etiology for femoral hernia?
Answer: The exact cause of femoral hernias is not known, but they are thought to occur due to weakness or defects in the abdominal wall- in the myopectineal orifice of Fruchaud. Factors that can contribute to the development of femoral hernias include pregnancy, obesity, chronic coughing, constipation, and heavy lifting. It is more common in females because of repeated pregnancies and wider pelvis resulting in wider femoral canal.
Q 6: What is the pathology of femoral hernia?
Answer: A femoral hernia occurs when a portion of the intestine or other abdominal contents protrude through the femoral canal, a small space located just below the inguinal ligament in the groin area. The hernia sac usually contains a loop of intestine, and in some cases, other abdominal organs such as omentum, bladder or uterus may also be involved.
Q 7: What are the clinical features in femoral hernia?
Answer: The clinical features of a femoral hernia can vary, but typically include a lump or bulge in the groin area which is below and lateral to pubic tubercle and that may be painful or tender to touch. In inguinal hernia the lump is above and medial to the pubic tubercle. The lump may increase in size with activities that increase intra-abdominal pressure, such as coughing or straining. Other symptoms may include nausea, vomiting, and constipation.
The sac cannot pass down into the thigh as the superficial fascia of the abdomen (fascia of Scarpa) is attached to the fascia lata of thigh at the lower border of the fossa ovalis. The shape of the sac thus becomes retort-shaped.
When obstruction and strangulation occurs which is more common, presents with features of intestinal obstruction—painful, tender, inflamed, irreducible swelling without any cough impulse. Richter’s hernia- that is gangrene of part of the circumference of the bowel is more common in femoral hernia.
Q 8: How will you differentiate femoral hernia from inguinal hernia?
Q 9: What is the treatment for femoral hernia?
Answer: The treatment of a femoral hernia typically involves surgery to repair the defect in the abdominal wall and return the abdominal contents to their normal position. This can be done using an open or laparoscopic approach, depending on the size and location of the hernia. In some cases, a mesh may be used to reinforce the repair.
In open surgery 3 approaches
1. Lotheissen’s operation: It is through inguinal canal approach. Transversalis fascia is opened and neck of the sac is identified in the femoral ring. Sac is dissected from above, neck is ligated and repair is done. After herniotomy, conjoined tendon is sutured to iliopectineal ligament by interrupted sutures (2 or 3), using nonabsorbable monofilament sutures.
2. Lockwood-low operation: This is by infra-inguinal approach. Here inguinal ligament is sutured to Cooper’s ligament. Fundus of sac is dissected by direct vision and repair is done from below.
3. Mc’Evedy-high operation: A incision is made over the femoral canal extending vertically above the inguinal ligament. Sac is dissected from below, neck from above and repair is done from above. It is done in strangulated femoral hernia.
4. Henry’s approach: Repair of bilateral femoral hernia through mid-line lower abdominal incision. Extra-peritonal femoral hernioplasty
5. Laparoscopic TAPP & TEP repairs:
Q 10: What are the post-op complications in femoral hernia?
Answer: Like any surgical procedure, there are risks and potential complications associated with the treatment of a femoral hernia. These include Seroma/ Hematoma, Urinary retention, Wound infection, Recurrence, Bleeding from aberrant obturator artery and Chronic neuralgic pain due to nerve injury or entrapment.
Bleeding from aberrant obturator artery is the dangerous complication because the patient may even bleed to death. Chronic neuralgic pain is due to nerve entrapment in the ligatures or due to nerve injury.
11.Host: That’s it for our podcast on femoral hernia. We hope that you found this information helpful. Thank you for listening and be sure to tune in next time for more informative discussions on various surgical topics. Bye-bye doctor and all the listeners.
Doctor: Hello MC Bye-Bye. See you all in the next episode.
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