Treatment of femoral hernia (femorocele, crural hernia) abroad
Femoral hernia presents itself as a protrusion of an intestine, omentum and a bladder through the femoral ring. Femorocele often affects babies under one year old and pregnant women. Defect imposes great danger to a patient’s life if not treated. Hernia is peculiar with the unfavorable clinical course with the increased risk of infringement, intestinal obstruction, and inflammatory complications.
Causes of femoral hernia
Femorocele occurs when elevated intra-abdominal pressure cannot be compensated by the resistance of connective tissue structures.
Risk factors for the disease are:
- Female sex as women have it 4 times more often than men because female pelvis is wider
- Childhood age, especially the first year of life. Hernia protrudes because of the weak connective tissue structures
- Ascites which is accumulation of fluid in the abdominal cavity
- Pregnancy (risk is higher with each pregnancy)
- Hip dislocations - congenital or acquired
- Drastic weight loss
- Abdominal trauma
- Postoperative scars
Factorsthat trigger hernia are:
- Excessive physical effort
- Persistent cough
- Retention of urine
- Efforts to go to to the bathroom while constipated
The inducing factors can be either momentary or time-stretched.
Symptoms of femoral hernia
Femoral hernia doesn’t have any symptoms at the early stages, but further patients indicate pain or discomfort. Unpleasant feelings occur while walking or during some other physical activity.
Hernia sac has a spherical shape, smooth, located above the inguinal fold when palpated (probed). Its size increases when straining and in the vertical position of the body.The repositioning of the femoral hernia into the abdominal cavity may be accompanied by a rumbling.
Positive symptom of a cough thrust is a distinctive feature of femoral hernia. A patient is asked to cough as intra-abdominal pressure increases while coughing and thrusts irradiate into the hernia protrusion. A doctor will feel the thrusts.
Rare symptoms of femoral hernia are:
- Swelling of the leg on the damaged side (consequence of femoral vein compression)
- Sensation of ‘crawling’ on the skin or numbness of the thigh skin (with compression of the nerves)
- Dysuric disorders (frequent urination or urinary retention) are observed if a bladder enters the hernia sac
They differentiate between reducible and irreducible hernia. It’s impossible to tuck in the irreducible hernia back into the abdominal cavity.
Femoral hernia is life-threatening if not treated as infringement can happen any moment. Then, such complications develop as:
- Intestinal necrosis
- Intestinal obstruction
- Purulent-septic inflammation and peritonitis
Hernia can be infringed even at the early stages (parietal infringement) of the disease when there are no any signs yet.
Diagnostics of femoral hernia
Patient complaints and physical exam help to diagnose femoral hernia. Visualization techniques such as ultrasound, X-ray, endoscopy are applied for the further verification.
Key diagnostic techniques are:
- Ultrasound of abdominal cavity and herniated protrusion
- Computed tomography
Modern hospitals can use MRI for diagnostics as it can identify herniated protrusion and contents of hernia sac.
Treatment of femoral hernia abroad
Femoral hernia is treated with surgery and there are many types of operations to remove the hernia. It depends on a hernia itself, presence or absence of infringement and also technical abilities of a hospital which kind of surgery to perform.
Main aim of an operation is hernia resection with defect plastic (hernial gates). Interventions are performed through various accesses like pelvic or femoral. The defect is closed by the patient's own tissues or synthetic polymeric nets. In the case of hernia infringement it is possible to perform a mid-laparotomy with the removal of non-viable areas of the intestine.
New therapy of femoral hernias. German hospitals and clinics of other developed states now prefer less invasive laparoscopic interventions. Just three small incisions are required to insert the surgical instruments and a camera to guidesurgeon.
Laparoscopic surgery can be done differently; relying on the type of hernia regardless, it has a number of benefits when compared to the conventional operations. A patient can go home next day after a surgery. Rehabilitation period goes quick and risk of complications is the lowest. Laparoscopy ensures good aesthetic results and doesn’t leave large scars on the body.
Prognosis for femoral hernia
There is nothing good to say if hernia is not treated as it becomes irreducible with time. As we know, infringement happens in 85% of patients with irreducible hernia. Then, such complications can occur as those ending in lethal outcome even after the emergency surgery.
Prognosis is determined by the type and severity of the pathological process.
Timely treatment of femoral hernia (scheduled surgery before any complications occur) gives a chance for a favorable prognosis. Patients completely restore their work capacity within several months and can go in for sports, participate in physical activities. Hernia recurrence is very rare today when modern types of surgery are performed. However, recurrence is possible when open surgery is done through the femoral access.