Femoral Hernia: Uncommon, but Associated With Potentially Severe Complications

Abstract

Background: Although the laparoscopic access is becoming the preferable treatment for femoral hernia, there are only few studies on this important subject. Aim: To assess the outcomes of the totally extraperitoneal laparoscopic (TEP) access in the treatment of femoral hernia. Methods: Data of 62 patients with femoral hernia who underwent herniorrhaphy were retrospectively reviewed. The diagnosis of femoral hernia was established by clinical and/or imaging exams in 55 patients and by laparoscopic findings in seven. Results: There were 55 (88.7%) females and 7 (11.3%) males, with female to male ratio of 8:1. The mean age was of 58.9±15.9 years, ranging from 22 to 92 years. Most patients (n=53; 85.5%) had single hernia and the remaining (n=9; 14.5%) bilateral, making a total of 71 hernias operated. Prior lower abdominal operations were recorded in 21 (33.9%) patients. Conversion to laparoscopic transabdominal preperitoneal procedure was performed in four (6.5%). Open herniorrhaphy was needed in two (3.2%), one with spontaneous enterocutaneous fistula in the groin region (Richter’s hernia) and the another with incidental perforation of the adjacent small bowel that occurred during dissection of hernia sac. There was no mortality. Conclusion: Femoral hernia is uncommon, and it may be associated with potentially severe complications. Most femoral hernias may be successfully treated with totally extraperitoneal laparoscopic access, with low conversion and complication rates.

Comparative Analysis of Conventional and Minimally Invasive Techniques in the Treatment of Femoral Hernias

“…Surgery is the only method of definitive treatment for femoral hernias. (van Veenendaal et al(2020), Coelho et al(2021), Peitsch WK. ( 2014)) Three classical approaches are known for this type of pathology: infra-, trans-and suprainguinal.…”

The Utility of Minimally Invasive Surgery in the Emergency Management of Femoral Hernias: A Systematic Review

“…There were no major complications reported, although the one patient with a prolonged stay secondary to a chest infection had a femoral hernia. Mean length of stay was 1.7 days (1-5) for under 60s and 3.5 for over 60s (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). There were no conversions to open surgery.…”

“…The femoral ring has relatively rigid borders, and therefore these hernias are prone to strangulation and often present as an emergency, with around 45% operated on as an emergency ( 1 ). West et al demonstrated the high complication rate of femoral hernias with 23.2% of patients operated on as an emergency requiring a small bowel resection and their high complication rate is well recognised ( 2 ). The relative tightness and rigidity of the femoral ring makes hernia reduction particularly difficult when compared with inguinal hernias.…”

De Garengeot’s hernia: A masked abdominal perforation

“…Anatomically, this canal is bordered by the inguinal ligament anteriosuperiorly, the femoral vein laterally, Cooper’s ligament inferiorly, lacunar ligament medially and the pectineal ligament posteriorly. These hernias typically present with a bulge below the right inguinal ligament and account for 3% of all hernias, but carry a high risk of strangulation, occurring in 15%–20% of cases (Coelho et al 2021).…”