Femoral Hernias

Question 1

What is a femoral hernia

Answer 1

Occurs when abdominal viscera/omentum passes through the femoral ring into the femoral canal and out of the saphenous opening

Question 2

How common are femoral hernias

Answer 2

They make up 5% of the abdominal hernias

And are more common in women

Question 3

What are the contents of the femoral canal from lateral to medial

Answer 3

N - femoral nerve 
A - femoral artery 
V - femoral vein 
E - empty space 
L - lymphatics

Question 4

what is the superior border of the femoral canal

Answer 4

Femoral ring that is covered by femoral septum - connective tissue Layer

Question 5

What are the risk factors of femoral hernias

Answer 5

Female

Pregnancy

Raised intra-abdominal pressure eg - heavy lifting, chronic cough, chronic constipation

Increasing age

Question 6

How will a patient with femoral hernias present

Answer 6

Small lump in the groin

Inferolateral to pubic tubercle ( while the inguinal hernia is superomedial to pubic tubercle )

Question 7

Why do femoral hernias have a high risk of strangulation

Answer 7

They have a narrow neck

Question 8

What are the differential diagnosis of groin lump

Answer 8

Inguinal hernia

Femoral canal lipoma

Lymph node

Saphena varix

Femoral artery aneurysm

Athletic pubalgia

Question 9

What investigations need to be carried out to investigate femoral hernias

Answer 9

It’s mainly a clincal diagnosis but additional images may be needed

USS

CT AP

If complications suspected then surgically explored

Question 10

How should you manage femoral hernias

Answer 10

Need to be surgically managed within 2 weeks of presentation as the risk of strangulation is quite high

Question 11

What are the two approaches taken in the surgical management of femoral hernias

Answer 11

Low approach

High approach

Question 12

What does the low approach entail

Answer 12

Incision is made below the inguinal ligament to help reduce the hernia and narrow the femoral ring however this incision results in limited space for the repair of the hernia

Question 13

What does the high approach entail

Answer 13

Incision is made above the inguinal ligament - this is preferred in the emergency setting as it allows easy access to the compromised small bowel

Question 14

How is the femoral ring narrowed

Answer 14

with sutures medially between the pectineal and inguinal ligaments or with a mesh plug

Question 15

What are the complications of a femoral hernia

Answer 15

Risk of strangulation increases with time

3 month strangulation risk is 22% and reaches 41% after 22 months

Risk of obstruction

Wound infection