​What is Surgery – Femoral Hernia Female

​What is Surgery – Femoral Hernia Female

Femoral Hernia
 DEFINITION
The aberrant protrusion of a peritoneal sac through the femoral canal, frequently containing abdominal contents. 

AETIOLOGY The structure of the femoral canal, with distinct unyielding borders of the anterior inguinal ligament, medial lacunar ligament, posterior pectineal (Cooper's) ligament and pubic bone, and laterally the femoral vein, is a predisposing factor of developing femoral hernia.Only loose connective tissue and a lymph node (Cloquet's node) normally make up the canal.

 RISK FACTORS/ASSOCIATIONS 
The angle between the inguinal ligament and the pectineal section of the pubic bone is wider in women, resulting in a broader femoral canal. Hernias are more likely to form when intra-abdominal pressure is raised (due to heavy lifting, coughing, or straining, for example, due to constipation or prostatism). 

EPIDEMIOLOGY 
It is twenty-five times lower than inguinal hernias.However it is 4 :1 ratio more common female than male. 

HISTORY 
Feeling unpleasant due to  lump or protrusion in the groin. Femoral hernias are frequently small and have a tight neck, so they go unnoticed until they become strangulated or obstructed, at which point they present as an emergency (up to 80% of the time) with pain, abdominal distention, nausea, and vomiting. 
EXAMINATION Swelling in the groin below and lateral to the pubic tubercle (which, if significant, may spread up and over the inguinal ligament) can be seen on close scrutiny.
 A cough impulse is not present over the inguinal ring. The hernia may be exceedingly tender if it is incarcerated or strangulated. Abdominal distension with tinkling bowel sounds if it is  obstructed. 

Inguinal hernia, lymphadenopathy, hydrocoele or lipoma of the spermatic cord (in men), groin or psoas abscess, saphaena varix, or femoral aneurysm are examples of differentials. 

INVESTIGATIONS
 FBC, U&Es, clotting, G&S, and ABG (for metabolic acidosis in bowel ischaemia).

AXR may reveal intestinal obstruction; 

USS if a different diagnosis is suspected; however, if an incarcerated hernia is suspected, imaging should not be used to delay surgery. It could be an unintentional finding, such as a CT scan. In circumstances where hernias are suspected, a herniogram can be performed as an elective procedure. 

MANAGEMENT 
In an emergency, resuscitation with rehydration and correction of electrolyte imbalances, insertion of an NG tube if vomiting, antibiotics if signs of sepsis, and surgical repair as the final treatment are all options. 

Surgery: Dissection of the sac, observation and reduction of the contents, excising the sac, and closing the defect, usually with non-absorbable sutures approximating the inguinal and pectineal ligaments (Cooper's ligament repair). A tension-free implantation of a mesh plug into the femoral canal is an alternative. 

TAPP or TEP methods can be used to do laparoscopic mesh repair. There are three main approaches to open surgery: 1. A low transverse incision (Lockwood) is made over the hernia (elective surgery).
 2. Transinguinal (Lotheissen) incision into the external oblique, inguinal canal, and transversalis fascia, above and parallel to the inguinal ligament (may have a higher recurrence rate). 3. The high (McEvedy) technique involves exposing the rectus sheath, retracting the rectus medially, and separating the transversalis fascia to expose the femoral canal through an oblique, paramedian, or unilateral Pfannenstiel incision. If strangulation is suspected, this is used. The contents of the sac are examined after it has been opened. If they are viable, they are decreased; if nonviable bowel is present, it is removed (a lower midline incision may be required if a high approach is not employed). 

COMPLICATIONS 
Femoral hernias frequently strangle, causing intestinal blockage, ischaemia, and gangrene, requiring surgical resection. Surgery: Bleeding (an anomalous obturator artery may be wounded if the lacunar ligament is incised to expand the canal); the risk of narrowing the femoral vein during surgery can result in venous thrombosis, infection, and seroma. 
PROGNOSIS With quick and suitable surgery, the outcome is usually good, and recurrence following repair is unusual (3 percent ).