Symptoms and indications for surgery for femoral hernia

A hernia appears in the area of weakened and pathologically enlarged areas of the muscles. With such a disease, the internal organs exit under the skin, a characteristic protrusion appears in the defect area. One type of this disease will be a femoral hernia that occurs in the region of the ring formed between the vein of the thigh and the lacunar region.

This pathology has several types, exhibits typical protrusion symptoms and is treated exclusively surgically. Femoral hernia in women appears more often, and there are prerequisites for it since birth. In men, this form of pathology is diagnosed relatively rarely.

How does a hernia occur?

The causes of the formation of femoral hernias can be different factors, but this happens according to the standard scheme. The pelvic bones and inguinal ligament are separated by a space filled with a vascular and muscular lacuna. The latter consists of muscles and the femoral nerve, between which there are lymph nodes and connective tissue. This area is called the femoral ring, through which the abdominal organs exit due to various internal and external pathological factors.

A femoral hernia in men and women is a round or oval formation in the area of the femoral triangle. The hernial sac often includes intestinal loops and omentum, so a strangulated femoral hernia threatens with intestinal obstruction.

The diagnosis with suspicion of this pathology is confirmed by ultrasound, herniography, irrigoscopy and other additional methods.

In operative gastroenterology, this disease occurs in 5-7% of all types of protrusions of the anterior abdominal wall. Hernias in women are diagnosed more often, due to the peculiarities of the anatomy of the pelvis and the physiological weakness of the connective tissue. The formation of a protrusion is characterized by the exit of organs beyond the boundaries of the abdominal wall through the femoral canal, and such a process can be unpredictable in terms of the development of complications.

Causes of the disease

There are the following factors for the appearance of a hernia on the thigh:

Sudden weight loss.
Traumatic injury to the peritoneum.
Postponed surgery.
Congenital dislocation of the hip.
Second and subsequent pregnancies.
Muscle weakness in children under one year old.

The immediate causes of the onset of pathology include conditions in which intra-abdominal pressure rises sharply. It can be sports, overeating, hysterical cough, heavy births, not the first, constipation.

Types of femoral hernias

The classification of pathology comes from the location of the protrusion and the severity of the course. There are unilateral and bilateral defects. Depending on the clinical manifestations, there are uncomplicated and strangulated femoral hernias.

The main types of hernias will be:

Reducible - the formation disappears on its own in the supine position, as well as with light pressure.
Irreducible - fixed and not set back, it slightly increases in size.
Strangulated - the contents of the hernial sac are compressed in the area of the gate, ischemia begins, necrotic processes occur, which is already life-threatening.

Muscular hernia is an acute condition, protrusion of organs due to muscle rupture. This disease is common among professional athletes. This form of the disease is manifested by severe pain and requires immediate surgery.

stages

A hernia in the thigh area develops in three stages:

Initial - localized behind the femoral ring, diagnosis at this stage is difficult, the symptoms are blurred, which leads to the transition to a running process. At the first stage of hernia formation with hidden signs, there is a high risk of strangulation.
Canal or incomplete - descends into the femoral canal, the protrusion passes into the area between the connective tissue and muscles.
Complete - located in the subcutaneous tissue, in men the protrusion goes into the scrotum, in women into the labia.

How does it manifest

At the initial stage of the pathology, a rounded small formation is seen in the area of the femoral-inguinal fold. Symptoms of a femoral hernia may not appear immediately, and an acute onset of the disease is also possible, when organs are infringed already at the time of the formation of the hernial sac. More often, intestinal loops and the omentum are infringed, as evidenced by pronounced signs in the form of intoxication, lack of stool, and severe pain in the lower abdomen.

A femoral hernia gives symptoms in the case of an uncomplicated course, but they are blurred and do not always force the patient to seek help from a doctor.

The main manifestations of the disease:

tumor formation in the area of the femoral-inguinal fold;
numbness of the skin of the legs and perineum;
rumbling when pressing on the hernia;
violation of local blood circulation due to compression of the femoral vein;
increase in education during coughing and physical exertion.

Pinching can occur at any stage of the pathological process. More often, complications occur with an asymptomatic course of the disease, when the diagnosis of a femoral hernia is possible only by ultrasound, because the external signs are similar to some other anomalies, including benign and malignant tumors.

At the initial stages of the pathology, the rounded formation has a size of no more than 3 cm, it is smooth to the touch and easily reduced. For the first time, a defect can be detected during physical work, with straining, a strong cough.

When a part of the intestine enters the hernial sac, the patient is disturbed by bloating, gas accumulates and stool is retained. When the bladder comes out under the skin in the thigh area, this will be accompanied by painful and frequent urination.

Complicated course

A hernia in the thigh area can become inflamed, and the pathological process begins in the area of the hernial sac. Purulent or serous inflammation quickly spreads to neighboring tissues, then the treatment of a femoral hernia will include not only the removal of the formation, but also the excision of areas of necrosis, and this is part of the intestine or bladder.

When a hernia of the muscle is detected, an additional examination of the gastrointestinal tract and small pelvis is carried out for differential diagnosis with oncology, cyst, inflammation of the tendons. Herniotomy in this case will be carried out immediately with suturing of the damaged aponeurosis.

Muscular hernia is determined immediately, severe muscle pain is felt, a formation appears, which is hard to the touch and gradually increases in size.

For a complicated hernia, the following manifestations are characteristic:

unbearable diffuse pains on the inner surface of the thigh and lower abdomen;
lack of stool, bloating, hardness of the abdominal wall;
lowering blood pressure, fever, tachycardia;
increase in education, its irreducibility.

A strangulated hernia requires urgent surgical intervention, because necrotic processes begin, poisoning the body with tissue decay products. The patient's condition without timely assistance is critical, a fatal outcome is possible.

Methods of treatment

The only way to get rid of a hernia is to remove the formation with the return of the organs to their place and suturing the defect. In case of muscle pathology, Bassini plastic surgery can be prescribed - this is a classic method of hernia repair with tension on the patient's tissues. There are several modifications of this operation, and the technique is already selected based on the patient's condition.

Before choosing a surgical technique, studies are prescribed: ultrasound, irrigoscopy, CT. Differential diagnosis is carried out with abscess, thrombophlebitis, lymphadenitis, varicose veins, metastases and neoplasms.

Operations for femoral hernias have the same goals - creating access to the protrusion with the least tissue injury, returning organs to their place and closing the muscle defect.

Standard hernioplasty is performed according to the following algorithm:

An incision of the hernial sac along the anterior surface at the bottom to the neck.
Content separation and inspection.
Return of organs.
Suturing the neck of the hernia sac with synthetic thread.
Removal of the hernial sac.
Plastic defect with own tissues.

Consequences and prognosis

The first alarm signal will be the irreducibility of education. From this moment on, we can expect infringement from a sudden movement, an increase in intra-abdominal pressure, and physical activity. But even a reducible hernia can be complicated by inflammation, peritonitis, intestinal obstruction, which will precede infringement.

The prognosis of the disease in an uncomplicated course is favorable.

There is always a risk of complications, and in the absence of treatment, about 85% of patients experience infringement. After the operation, it is important to observe the prevention of re-protrusion and complications. To this end, the doctor prescribes wearing a bandage, diet, moderate exercise, physiotherapy.