Femoral Hernia Repair

A femoral hernia repair can be carried out as either open surgery or keyhole surgery (also called laparoscopic surgery) and should take about 30 to 45 minutes.

The advantages and disadvantages of both techniques should be discussed with your surgeon before deciding on the most appropriate treatment. The National Institute for Health and Care Excellence (NICE), which assesses medical treatments for the NHS, says both techniques are safe and work well, and the risk of your hernia returning is similar for both.

The choice of repair technique largely depends on:

• Your general health. Elderly people or people in bad health may be too weak or frail to safely have a general anaesthetic, so open surgery under local anaesthetic may be advised.
• The experience of your surgeon. Open surgery is more common than keyhole surgery, so not all surgeons have enough experience in keyhole techniques.

General or regional/local anaesthetic are both options for open surgery. Using a regional or local anaesthetic means you will be awake during the procedure, but the area being operated on will be numb and you will not experience any pain.

During open surgery to repair a femoral hernia, the surgeon makes a single 3 to 4cm long cut in your lower tummy or over the hernia. The femoral canal (a channel containing the main blood vessels and nerves leading to the thigh) is opened and the surgeon places the lump of fatty tissue or loop of bowel back into your tummy. The femoral canal is then closed, often with a mesh plug, to strengthen the weak spot that let the hernia through. The incision is then sealed with stitches which usually dissolve on their own over the course of a few days after the operation.

We will give you detailed instructions about anything you need to do before your operation, such as when to stop eating and drinking.

Keyhole surgery can be useful if your surgeon is not sure exactly what type of hernia you have. There is usually less pain after the operation because the cuts are smaller but the risk of serious complications, such as the surgeon accidentally damaging the bowel, can be a bit higher with this technique.

During keyhole surgery, several very small incisions are made instead of a single, larger incision. A thin tube containing a light and a camera (laparoscope) is inserted through one of the incisions, so the surgeon can see inside your tummy. Surgical instruments are inserted through the other incisions, so the surgeon can pull the hernia back into place. As with open surgery, a mesh patch is often used to strengthen the weak spot in the tummy where the hernia came through. Once the repair is complete, the incisions in your skin are sealed with stitches or surgical glue.

You will usually be able to go home on the same day of your operation. Please arrange for a friend or family member to drive you home in a car or order a taxi. An adult must stay with you for the first 24 hours after your operation, in case you experience any problems.

After the operation, your groin will feel sore and uncomfortable, and you will be given painkillers to help relieve the pain. If you are still in pain after going home, continue taking painkillers as advised by the hospital.

Applying gentle pressure to your wound using your hand or a small pillow can make coughing, sneezing and moving between sitting and standing more comfortable.

Make sure you follow the instructions our medical team give you about caring for your wound, hygiene and bathing.

Straining on the toilet because of constipation can cause pain around your wound. You can reduce your risk of constipation by drinking lots of fluids and eating plenty of vegetables, fruit and high-fibre foods, such as brown rice, wholemeal bread and pasta. A mild, over-the-counter laxative may also help.

If the operation was carried out under a general anaesthetic, your co-ordination and reasoning may be affected for a short time. Avoid drinking alcohol, operating machinery or signing legal documents for 24 to 48 hours after any operation involving general anaesthetic.

Over time, you can gradually return to your normal activities as soon as you are able to do them without feeling any pain. Most people can do light activities, such as shopping after one or two weeks.

You should be able to return to work after two or three weeks, although you may need more time off if your job involves manual labour.

Gentle exercise, such as walking, can help the healing process, but you should avoid heavy lifting and strenuous activities for about six weeks. You should also not play football for eight weeks and rugby for at least 12 weeks.

It is usually fine to have sex when you feel ready, but you may it painful or uncomfortable at first.

Speak to the medical professional in charge of your care for advice about when you can drive. It is usually advisable to avoid driving until you can perform an emergency stop without feeling any pain or discomfort. You can practice this without starting your car. It will usually be one or two weeks before you reach this point after having keyhole surgery, although it may take longer after open surgery. We recommended you contact your car insurance company before starting to drive again.

Please call your consultant, GP or dial 111 for advice if you develop any of the following symptoms:

• A persistent high temperature.
• Persistent or heavy bleeding.
• Increased swelling or pain in your tummy.
• Pain that is not relieved by painkillers.
• Persistent nausea or vomiting.
• Chills.
• Persistent coughing or shortness of breath.
• Increasing redness around your incisions.
• Difficulty peeing.