From the Guidelines
Surgical repair is the definitive treatment for left femoral hernias, and it should be performed as soon as possible to prevent complications such as incarceration or strangulation, which can significantly increase morbidity and mortality rates 1.
Key Considerations
- The risk of strangulation is high in femoral hernias, and early detection is crucial to prevent severe complications 1.
- The use of mesh in clean surgical fields is associated with lower recurrence rates and is recommended for patients with intestinal incarceration and no signs of intestinal strangulation or concurrent bowel resection (grade 1A recommendation) 1.
- Patients should avoid heavy lifting and straining while awaiting surgery and seek immediate medical attention if they experience severe pain, nausea, vomiting, or inability to reduce the hernia, as these may indicate strangulation requiring emergency surgery.
Diagnostic Considerations
- Systemic inflammatory response syndrome (SIRS), contrast-enhanced CT findings, as well as lactate, serum creatinine phosphokinase (CPK), and D-dimer levels are predictive of bowel strangulation (grade 1C recommendation) 1.
- Elevated D-dimer levels measured upon admission were found to correlate strongly with intestinal ischemia 1.
- Arterial blood lactate level of 2.0 mmol/L or greater was a useful predictor of non-viable bowel strangulation 1.
Treatment Approach
- Surgical repair can be performed via open surgery or laparoscopically, depending on patient factors and surgeon preference.
- Prosthetic repair with a synthetic mesh is recommended for patients with intestinal incarceration and no signs of intestinal strangulation or concurrent bowel resection (clean surgical field) (grade 1A recommendation) 1.
- Early detection and treatment of complicated abdominal hernias may be the best means of reducing the rate of mortality 1.
From the Research
Left Femoral Hernia
- A left femoral hernia is a type of hernia that occurs when tissue, such as part of the intestine, protrudes through a weak spot in the abdominal wall in the groin area 2.
- Femoral hernias are less common than inguinal hernias, but they can be more dangerous if left untreated, as they can lead to complications such as bowel incarceration, obstruction, and strangulation 3, 2.
Diagnosis and Treatment
- Diagnosis of a left femoral hernia can be made through physical examination, ultrasonography, or other imaging tests such as magnetic resonance imaging (MRI) or herniography 2.
- Treatment options for left femoral hernia include watchful waiting, open repair, and laparoscopic repair 2, 4.
- Laparoscopic repair is associated with shorter recovery time, less pain, and lower recurrence rates compared to open repair 2, 5.
- Mesh repair is also a common approach, which probably reduces the rate of hernia recurrence and visceral or neurovascular injuries compared to non-mesh repair 4.
Outcomes and Quality of Life
- Outcomes and quality of life (QOL) after left femoral hernia repair can be evaluated using the Carolinas Comfort Scale (CCS) 5.
- A study found that QOL outcomes at all time points demonstrated no difference for pain, movement limitation, or mesh sensation between laparoscopic and open techniques 5.
- Postoperative QOL scores improved for both groups when compared to preoperative scores, suggesting that both laparoscopic and open repair can improve QOL after left femoral hernia repair 5.
Complications and Risks
- Complications of left femoral hernia repair can include abdominal wall complications, seroma formation, wound infection, and testicular complications 4.
- The risk of complications can be reduced by using mesh repair, which probably reduces the rate of hernia recurrence and visceral or neurovascular injuries compared to non-mesh repair 4.
- However, mesh repair may result in a higher risk of seroma formation and wound swelling compared to non-mesh repair 4.