Miami Hernia Center

Inguinal Hernia and Femoral Hernia

 

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What is an Inguinal Hernia?

An inguinal hernia occurs when part of the abdominal cavity, sometimes fat or intestines, bulges through an opening in the groin muscles. This bulge sometimes stays limited to the groin or goes down to the scrotal area in men, depending on the type of inguinal hernia. Inguinal hernias account for approximately 75-80% of all hernias and they are most common in men. A hernia is called a “reducible hernia” when the bulge can be pushed back into the abdomen. An incarcerated or a “non-reducible hernia” occurs when the contents inside the hernia sac cannot be pushed back into their normal anatomic position inside the abdomen. Incarcerated hernias can sometimes become “strangulated” when the blood supply to the organs that are entrapped (intestines or fat or other organs) becomes compromised and the tissue dies. This is a surgical emergency and is one of the reasons why hernias should be fixed in the first place in order to prevent this type of complication.

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What is a Femoral Hernia?

A femoral hernia is a bulge that appears in the groin, sometimes upper thigh or near the "labia" (skin folds at the vaginal opening). They are more common in females (10 times more common in females but they do occur in males as well) and have a high risk of becoming strangulated. They should always be repaired surgically. Femoral hernias are often hard to distinguish from inguinal hernias on physical examination, but they typically occur lower in the groin near the inner thigh. In general, they are treated surgically the same way as inguinal hernias. Many times, a Femoral Hernia can occur at the same time of an Inguinal Hernia and they are often overlooked at surgery using 'conventional' repair techniques.

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Symptoms of an Inguinal Hernia

The most common signs and symptoms of an inguinal hernia are pain in the groin or scrotum (in men) associated with a bulge. This bulge can increase in size with coughing, straining, pushing, heavy lifting or any maneuver that increases the intra-abdominal pressure. When the hernia is strangulated, sharp pain, redness of the surrounding skin, nausea, vomiting and intestinal obstruction can occur.

 

 

Diagnosis of an Inguinal Hernia

Most inguinal hernias are diagnosed on physical examination by an experienced physician or Hernia specialist. Sometimes with non-palpable hernias or in the obese patient additional tests are indicated to help in the diagnosis including groin ultrasound, CT scan of the abdomen and pelvis or MRI.

 

 

Treatment of Inguinal Hernias

Inguinal hernias can be repaired either via an open approach or a laparoscopic / robotic approach. With an open approach a small incision is made in the groin and the hernia is repaired either using a “tension-free” technique with the placement of a prosthesis or mesh or using a “suture” technique, where no mesh is placed and the muscles and tissues are sutured together in order to close the defect. For laparoscopic and robotic approaches,  three small incisions are made in the abdomen (near the area of the umbilicus) through which long instruments are placed and the hernia is repaired with mesh.

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Anesthesia

Most open inguinal and femoral hernias can be fixed with local anesthesia and intravenous sedation. Sometimes general anesthesia is required depending on the patient’s conditions and the size of the hernia. For laparoscopic or robotic repair, general anesthesia is required.