Femoral Hernia
Approach
- Expose patient as for inguinal hernia examination
- Inspect
- Marble shaped lump in the groin
- May be scar from previous surgery
- 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
- Percuss
- Auscultate
Completion
- 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
- Skin and soft tissue masses
- Sebaceous cyst
- Lipoma
- Sarcoma
- Vascular masses
- Saphena varix
- Femoral aneurysm
- Inguinal lymphadenopathy
- Other herniae
- Inguinal hernia
- Obturator hernia
- Others
- Psoas bursa
- Ectopic testis
Surgical options
- Reduction of contents of sac
- Excision of sac
- Repair of defect
- 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
- 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
- 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
