What intervention is recommended for a left femoral hernia containing fat?

From the Guidelines

Elective surgical repair is generally recommended for a left fat-containing femoral hernia due to the high risk of incarceration and strangulation associated with femoral hernias. The preferred surgical approach is an open repair using either a low approach (Lockwood), high approach (McEvedy), or preperitoneal approach (Cheatle-Henry), with mesh reinforcement being the standard of care to reduce recurrence rates 1. Laparoscopic repair is also an option, particularly for bilateral or recurrent hernias. While waiting for surgery, patients should avoid heavy lifting, maintain a healthy weight, treat chronic cough if present, and seek immediate medical attention if the hernia becomes painful, irreducible, or associated with nausea, vomiting, or abdominal distension, as these may indicate incarceration or strangulation requiring emergency surgery. The presence of fat in the hernia sac (as opposed to bowel) may have a slightly lower risk of complications, but surgical repair remains the definitive treatment to prevent future complications.

Some key points to consider in the management of femoral hernias include:

• The risk of incarceration and strangulation is high, ranging from 10-50% 1
• Early surgical intervention is critical in cases of suspected strangulation, as delayed diagnosis can lead to septic complications and increased morbidity and mortality 1
• The use of mesh in clean surgical fields (CDC wound class I) is associated with lower recurrence rates, without an increase in wound infection rates 1
• In cases of clean-contaminated surgical fields (CDC wound class II), emergent prosthetic repair with a synthetic mesh can be performed, with a significant lower risk of recurrence 1

It is essential to note that the management of femoral hernias should be individualized, taking into account the patient's overall health, the presence of any comorbidities, and the specific characteristics of the hernia. However, elective surgical repair remains the recommended treatment for asymptomatic and reducible femoral hernias, due to the high risk of complications associated with incarceration and strangulation 1.

From the Research

Intervention for Left Fat-Containing Femoral Hernia

• Laparoscopic repair is a viable option for left fat-containing femoral hernia, as demonstrated in a case report where a 73-year-old woman underwent elective laparoscopic surgery for an irreducible femoral hernia containing an epiploic appendage of the sigmoid colon 2.
• The laparoscopic approach can be used to repair incarcerated femoral hernias, with studies showing that it is a safe and effective option 3, 4.
• Totally extraperitoneal laparoscopic access is also a suitable method for treating femoral hernia, with low conversion and complication rates 5.
• Emergency femoral hernia repair is often necessary, and laparoscopic repair can be used in these cases, although it may require more time and specialized skills 4, 6.
• The use of mesh in femoral hernia repair is recommended, as it results in fewer re-operations than suture repairs 6.
• Femoral hernias are more common in women and can lead to a higher rate of bowel resection and mortality if not operated on promptly, emphasizing the importance of early intervention 6.