Advertisement

Femoral Hernia

  • Ursula Dahlstrand
Chapter

Abstract

Femoral hernias are not as common as inguinal hernias. They only constitute about 1/30 of all groin hernias. This makes them more difficult to study than inguinal hernias, and literature on the subject is unfortunately rather sparse. However, femoral hernias are clinically of great significance due to their propensity for emergency presentation. They have a higher risk for strangulation and need for bowel resection during surgery. Linked to this is a higher morbidity and mortality than for inguinal hernia, even if no such over-risk is seen for the electively repaired hernias. Femoral hernias are more common in women with a steady increase in risk for occurrence throughout life. Several surgical approaches and techniques have been described. Femoral hernias should be repaired electively with a preperitoneal mesh repair technique whenever possible.

Keywords

Hernia Femoral Epidemiology Diagnosis Strangulated hernia Surgical approaches 

Notes

Acknowledgment

This is an updated version of the chapter authored by Patrick J. O’Dwyer. Patrick J. O’Dwyer has not participated in the revision of this chapter for the fifth edition.

References

  1. 1.
    Moschcowitz AV. Prevascular femoral hernia. Ann Surg. 1912;55(6):848–56.CrossRefGoogle Scholar
  2. 2.
    Stevens A. Health care needs assessment: the epidemiologically based needs assessment reviews, vol. 1. Radcliffe; 2004.Google Scholar
  3. 3.
    Dahlstrand U, Wollert S, Nordin P, Sandblom G, Gunnarsson U. Emergency femoral hernia repair: a study based on a national register. Ann Surg. 2009;249(4):672–6.  https://doi.org/10.1097/SLA.0b013e31819ed943.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Bay-Nielsen M, Kehlet H, Strand L, Malmstrom J, Andersen F, Wara P, et al. Quality assessment of 26,304 herniorrhaphies in Denmark: a prospective nationwide study. Lancet. 2001;358(9288):1124–8.  https://doi.org/10.1016/s0140-6736(01)06251-1.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Glassow F. Femoral hernia. Review of 2,105 repairs in a 17 year period. Am J Surg. 1985;150(3):353–6.CrossRefGoogle Scholar
  6. 6.
    Putnis S, Wong A, Berney C. Synchronous femoral hernias diagnosed during endoscopic inguinal hernia repair. Surg Endosc. 2011;25(12):3752–4.  https://doi.org/10.1007/s00464-011-1781-3.CrossRefPubMedGoogle Scholar
  7. 7.
    Rath A, Bhatia P, Kalhan S, John S, Khetan M, Bindal V, et al. Endoscopic TEP inguinal hernia repair in the management of occult obturator and femoral hernias. Surg Laparosc Endosc Percutan Tech. 2014;24(4):375–7.  https://doi.org/10.1097/SLE.0b013e3182901509.CrossRefPubMedGoogle Scholar
  8. 8.
    Andresen K, Bisgaard T, Kehlet H, Wara P, Rosenberg J. Reoperation rates for laparoscopic vs open repair of femoral hernias in Denmark: a nationwide analysis. JAMA Surg. 2014;149(8):853–7.  https://doi.org/10.1001/jamasurg.2014.177.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Swedish Hernia Register T. Annual report 2015, www.svensktbrackregister.se. 2016. http://www.svensktbrackregister.se/rapporter-71/verksamhetsberaettelser. Accessed Feb 25 2017.
  10. 10.
    Odula P, Kakande I. Femoral hernia at Mulago hospital. East Central Afr J Surg. 2004;9(2):74–7.Google Scholar
  11. 11.
    Berliner SD, Burson LC, Wise L. The Henry operation for incarcerated and strangulated femoral hernias. Arch Surg. 1992;127(3):314–6. discussion 6CrossRefGoogle Scholar
  12. 12.
    McEvedy PG. Femoral hernia. Ann R Coll Surg Engl. 1950;7(6):484–96.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Ludington LG. Femoral hernia and its management, with particular reference to its occurrence following inguinal herniorrhaphy. Ann Surg. 1958;148(5):823–6.CrossRefGoogle Scholar
  14. 14.
    Burton CC, Bauer R. Femoral hernia; a review of 165 repairs. Ann Surg. 1958;148(6):913–8.CrossRefGoogle Scholar
  15. 15.
    Ponka JL, Brush BE. Problem of femoral hernia. Arch Surg. 1971;102(4):417–23.CrossRefGoogle Scholar
  16. 16.
    Mikkelsen T, Bay-Nielsen M, Kehlet H. Risk of femoral hernia after inguinal herniorrhaphy. Br J Surg. 2002;89(4):486–8.  https://doi.org/10.1046/j.0007-1323.2002.02058.x.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Burcharth J, Pedersen M, Bisgaard T, Pedersen C, Rosenberg J. Nationwide prevalence of groin hernia repair. PLoS One. 2013;8(1):e54367.  https://doi.org/10.1371/journal.pone.0054367.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Rosemar A, Angerås U, Rosengren A, Nordin P. Effect of body mass index on groin hernia surgery. Ann Surg. 2010;252(2):397–401.  https://doi.org/10.1097/SLA.0b013e3181e985a1.CrossRefPubMedGoogle Scholar
  19. 19.
    Hair A, Paterson C, O’Dwyer PJ. Diagnosis of a femoral hernia in the elective setting. J R Coll Surg Edinb. 2001;46(2):117–8.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Robinson P, Hensor E, Lansdown MJ, Ambrose NS, Chapman AH. Inguinofemoral hernia: accuracy of sonography in patients with indeterminate clinical features. AJR Am J Roentgenol. 2006;187(5):1168–78.  https://doi.org/10.2214/AJR.05.1251.CrossRefPubMedGoogle Scholar
  21. 21.
    Bradley M, Morgan D, Pentlow B, Roe A. The groin hernia – an ultrasound diagnosis? Ann R Coll Surg Engl. 2003;85(3):178–80.  https://doi.org/10.1308/003588403321661334.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Bradley M, Morgan J, Pentlow B, Roe A. The positive predictive value of diagnostic ultrasound for occult herniae. Ann R Coll Surg Engl. 2006;88(2):165–7.  https://doi.org/10.1308/003588406X95110.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Djuric-Stefanovic A, Saranovic D, Ivanovic A, Masulovic D, Zuvela M, Bjelovic M, et al. The accuracy of ultrasonography in classification of groin hernias according to the criteria of the unified classification system. Hernia. 2008;12(4):395–400.  https://doi.org/10.1007/s10029-008-0352-6.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Corder AP. The diagnosis of femoral hernia. Postgrad Med J. 1992;68(795):26–8.CrossRefGoogle Scholar
  25. 25.
    Nilsson H, Stylianidis G, Haapamaki M, Nilsson E, Nordin P. Mortality after groin hernia surgery. Ann Surg. 2007;245(4):656–60.  https://doi.org/10.1097/01.sla.0000251364.32698.4b. 00000658-200704000-00024 [pii]CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Chamary VL. Femoral hernia: intestinal obstruction is an unrecognized source of morbidity and mortality. Br J Surg. 1993;80(2):230–2.CrossRefGoogle Scholar
  27. 27.
    Akinci M, Ergül Z, Kulah B, Yilmaz KB, Kulacoğlu H. Risk factors related with unfavorable outcomes in groin hernia repairs. Hernia. 2010;14(5):489–93.  https://doi.org/10.1007/s10029-010-0683-y.CrossRefPubMedGoogle Scholar
  28. 28.
    Kurt N, Oncel M, Ozkan Z, Bingul S. Risk and outcome of bowel resection in patients with incarcerated groin hernias: retrospective study. World J Surg. 2003;27(6):741–3.  https://doi.org/10.1007/s00268-003-6826-x.CrossRefPubMedGoogle Scholar
  29. 29.
    Roth N, Gangl O, Havlicek W, Függer R. The impact of emergency surgery on results of femoral hernia repair. Eur Surg. 2010;42(6):299–303.  https://doi.org/10.1007/s10353-010-0573-7.CrossRefGoogle Scholar
  30. 30.
    Dahlstrand U, Sandblom G, Wollert S, Gunnarsson U. Limited potential for prevention of emergency surgery for femoral hernia. World J Surg. 2014;38(8):1931–6.  https://doi.org/10.1007/s00268-014-2539-6.CrossRefPubMedGoogle Scholar
  31. 31.
    McEntee GP, O’Carroll A, Mooney B, Egan TJ, Delaney PV. Timing of strangulation in adult hernias. Br J Surg. 1989;76(7):725–6.CrossRefGoogle Scholar
  32. 32.
    Chan G, Chan C. Longterm results of a prospective study of 225 femoral hernia repairs: indications for tissue and mesh repair. J Am Coll Surg. 2008;207(3):360–7.  https://doi.org/10.1016/j.jamcollsurg.2008.04.018.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Gallegos NC, Dawson J, Jarvis M, Hobsley M. Risk of strangulation in groin hernias. Br J Surg. 1991;78(10):1171–3.CrossRefGoogle Scholar
  34. 34.
    Kulah B, Duzgun AP, Moran M, Kulacoglu IH, Ozmen MM, Coskun F. Emergency hernia repairs in elderly patients. Am J Surg. 2001;182(5):455–9.CrossRefGoogle Scholar
  35. 35.
    Alvarez JA, Baldonedo RF, Bear IG, Solis JA, Alvarez P, Jorge JI. Incarcerated groin hernias in adults: presentation and outcome. Hernia. 2004;8(2):121–6.  https://doi.org/10.1007/s10029-003-0186-1.CrossRefPubMedGoogle Scholar
  36. 36.
    Ge BJ, Huang Q, Liu LM, Bian HP, Fan YZ. Risk factors for bowel resection and outcome in patients with incarcerated groin hernias. Hernia. 2010;14(3):259–64.  https://doi.org/10.1007/s10029-009-0602-2.CrossRefPubMedGoogle Scholar
  37. 37.
    Alimoglu O, Kaya B, Okan I, Dasiran F, Guzey D, Bas G, et al. Femoral hernia: a review of 83 cases. Hernia. 2005;10(1):70–3.  https://doi.org/10.1007/s10029-005-0045-3.CrossRefPubMedGoogle Scholar
  38. 38.
    Nicholson S, Keane TE, Devlin HB. Femoral hernia: an avoidable source of surgical mortality. Br J Surg. 1990;77(3):307–8.CrossRefGoogle Scholar
  39. 39.
    Nilsson H, Nilsson E, Angeras U, Nordin P. Mortality after groin hernia surgery: delay of treatment and cause of death. Hernia. 2011;15(3):301–7.  https://doi.org/10.1007/s10029-011-0782-4.CrossRefPubMedGoogle Scholar
  40. 40.
    Kjaergaard J, Bay-Nielsen M, Kehlet H. Mortality following emergency groin hernia surgery in Denmark. Hernia. 2010;14(4):351–5.  https://doi.org/10.1007/s10029-010-0657-0.CrossRefPubMedGoogle Scholar
  41. 41.
    Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, et al. European hernia society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13(4):343–403.  https://doi.org/10.1007/s10029-009-0529-7.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    van den Heuvel B, Dwars BJ, Klassen DR, Bonjer HJ. Is surgical repair of an asymptomatic groin hernia appropriate? A review. Hernia. 2011;15(3):251–9.  https://doi.org/10.1007/s10029-011-0796-y.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Tingwald GR, Cooperman M. Inguinal and femoral hernia repair in geriatric patients. Surg Gynecol Obstet. 1982;154(5):704–6.PubMedGoogle Scholar
  44. 44.
    Gianetta E, de Cian F, Cuneo S, Friedman D, Vitale B, Marinari G, et al. Hernia repair in elderly patients. Br J Surg. 1997;84(7):983–5.CrossRefGoogle Scholar
  45. 45.
    Scott NW, McCormack K, Graham P, Go PM, Ross SJ, Grant AM. Open mesh versus non-mesh for repair of femoral and inguinal hernia. Cochrane Database Syst Rev. 2002;4:CD002197.  https://doi.org/10.1002/14651858.CD002197.CrossRefGoogle Scholar
  46. 46.
    Chen J, Lv Y, Shen Y, Liu S, Wang M. A prospective comparison of preperitoneal tension-free open herniorrhaphy with mesh plug herniorrhaphy for the treatment of femoral hernias. Surgery. 2010;148(5):976–81.  https://doi.org/10.1016/j.surg.2010.02.006.CrossRefPubMedGoogle Scholar
  47. 47.
    Dahlstrand U, Sandblom G, Nordin P, Wollert S, Gunnarsson U. Chronic pain after femoral hernia repair: a cross-sectional study. Ann Surg. 2011;254(6):1017–21.  https://doi.org/10.1097/SLA.0b013e31822ba9b6.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Cox TC, Huntington CR, Blair LJ, Prasad T, Heniford BT, Augenstein VA. Quality of life and outcomes for femoral hernia repair: does laparoscopy have an advantage? Hernia. 2017;21(1):79–88.  https://doi.org/10.1007/s10029-016-1502-x.CrossRefPubMedGoogle Scholar
  49. 49.
    Nyhus LM, Condon RE, Harkins HN. Clinical experiences with preperitoneal hernial repair for all types of hernia of the groin, with particular reference to the importance of transversalis fascia analogues. Am J Surg. 1960;100:234–44.CrossRefGoogle Scholar
  50. 50.
    Henry A. Operation for femoral hernia by a midline extraperitoneal approach. Lancet. 1936;227(5871):531–3.  https://doi.org/10.1016/S0140-6736(01)36573-X.CrossRefGoogle Scholar
  51. 51.
    Smith WR, Moore EE, Osborn P, Agudelo JF, Morgan SJ, Parekh AA, et al. Retroperitoneal packing as a resuscitation technique for hemodynamically unstable patients with pelvic fractures: report of two representative cases and a description of technique. J Trauma. 2005;59(6):1510–4.CrossRefGoogle Scholar
  52. 52.
    Hachisuka T. Femoral hernia repair. Surg Clin North Am. 2003;83(5):1189–205.CrossRefGoogle Scholar
  53. 53.
    Sanchez-Bustos F, Ramia JM, Fernandez Ferrero F. Prosthetic repair of femoral hernia: audit of long term follow-up. Eur J Surg. 1998;164(3):191–3.  https://doi.org/10.1080/110241598750004634.CrossRefPubMedGoogle Scholar
  54. 54.
    Song Y, Lu A, Ma D, Wang Y, Wu X, Lei W. Long-term results of femoral hernia repair with ULTRAPRO plug. J Surg Res. 2015;194(2):383–7.  https://doi.org/10.1016/j.jss.2014.10.058.CrossRefPubMedGoogle Scholar
  55. 55.
    Allan SM, Heddle RM. Prolene plug repair for femoral hernia. Ann R Coll Surg Engl. 1989;71(4):220–1.PubMedPubMedCentralGoogle Scholar
  56. 56.
    Pangeni A, Shakya VC, Shrestha AR, Pandit R, Byanjankar B, Rai S. Femoral hernia: reappraisal of low repair with the conical mesh plug. Hernia. 2017;21(1):73–7.  https://doi.org/10.1007/s10029-016-1500-z.CrossRefPubMedGoogle Scholar
  57. 57.
    Lichtenstein IL, Shore JM. Simplified repair of femoral and recurrent inguinal hernias by a “plug” technic. Am J Surg. 1974;128(3):439–44.CrossRefGoogle Scholar
  58. 58.
    Robbins AW, Rutkow IM. Mesh plug repair and groin hernia surgery. Surg Clin North Am. 1998;78(6):1007–23, vi–vii.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Clinical Science, Intervention and TechnologyKarolinska Institutet and Center for Digestive Diseases, Karolinska University HospitalSolnaSweden

Personalised recommendations