Hernia, femoral - How femoral hernia repair is carried out

There are two ways a femoral hernia repair can be carried out. These are known as open surgery or keyhole surgery (also called laparoscopic surgery).

The hospital will send instructions about when you need to stop eating and drinking before the operation.

Femoral hernia repair is usually carried out under general anaesthetic, which means you will be asleep during the procedure and won't feel any pain.

However, regional or local anaesthetic is sometimes used for open surgery. This means you will be awake during the procedure but the area being operated on will be numbed so you won't experience any pain.

The operation should take about 30-45 minutes to complete and you will usually be able to go home on the same day. Some people stay in hospital overnight if they have other medical problems or if they live alone.

Read more about recovering from femoral hernia repair.

Open surgery

During open surgery to repair a femoral hernia, the surgeon makes a single cut (incision) in your lower abdomen (tummy) or over the hernia. This incision is usually about 3-4cm long.

The femoral canal (a channel containing the main blood vessels and nerves leading to the thigh) is opened and the surgeon will then place the lump of fatty tissue or loop of bowel back into your abdomen.

The femoral canal is then closed with a mesh plug to repair the weak spot that let the hernia through.

The incision in your skin is then sealed with stitches. These are usually a type that dissolve on their own over the days following the operation.

If the hernia has become trapped (strangulated) and part of the bowel damaged, the affected segment may need to be removed and the two ends of healthy bowel rejoined. This is a bigger operation and you may need to stay in hospital for four to five days.

Keyhole (laparoscopic) surgery

During keyhole surgery to repair a femoral hernia, three very small incisions are usually made instead of a single, larger incision. One incision, about 1.5cm long, is made below the belly button and two incisions, about 0.5cm long, are made to the sides of this main incision.

A thin tube containing a light source and a camera (laparoscope) is inserted through the largest of these incisions so the surgeon can see inside your abdomen.

Special 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 abdomen where the hernia came through.

Once the repair is complete, the incisions in your skin are sealed with stitches or surgical glue.

Which technique is best?

The National Institute for Health and Care Excellence (NICE), which assesses medical treatments for the NHS, says that both keyhole and open surgery for hernias are safe and work well.

With keyhole surgery, there is usually less pain after the operation because the cuts are smaller.

However, the risks of serious complications, such as the surgeon accidentally damaging the bowel, are also higher in keyhole surgery.

The risk of your hernia returning is similar for both operations.

Discuss the advantages and disadvantages of keyhole surgery and open surgery with your surgeon before deciding on the most appropriate treatment.

Deciding which technique to use

The choice of technique for femoral hernia repair will largely depend 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

Keyhole surgery can be useful if your surgeon is not sure exactly what type of hernia you have.