There are two ways that a femoral hernia repair can be carried out. These are known as open surgery or keyhole surgery (also called laparoscopic surgery).
The operation
The hernia repair should take about 45 minutes. The hospital will send instructions about when you need to stop eating and drinking before the operation.
You will usually be able to go home on the same day, but some people stay in hospital overnight if they have other medical problems or live alone. Read more information about recovering from a femoral hernia repair.
Open surgery
- The surgeon makes a large (3–4cm) cut in your lower abdomen or over the hernia.
- The femoral canal (a channel near your bowel) is opened to return the fatty lump or loop of bowel to your abdomen, where it should be.
- The canal is closed with a mesh plug to repair the weak spot that let the hernia through.
- The wall of your abdomen may be strengthened by fixing a patch of nylon mesh to it.
- 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
- With keyhole surgery, three very small cuts are required – one (1.5cm) below the belly button and one (0.5cm) either side of it.
- A specially designed camera and instruments are used to push the fatty lump or loop of bowel back into your abdomen.
- The hernia is repaired from the inside using a mesh patch in the same way as with open surgery.
What are the advantages and disadvantages?
The National Institute for Health and Clinical 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, there is no muscle damage with a mesh repair and the small cuts can be closed with glue.
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.
Open surgery or keyhole?
Your choice will depend on:
- Whether you can have a general anaesthetic. Elderly people or people in bad health may be too weak or frail to safely have a general anaesthetic, so may be advised to have open surgery, which can be done under local anaesthetic (where the area is numbed).
- The experience of your surgeon. Open surgery is more common than keyhole surgery, partly because not all surgeons have enough experience in keyhole techniques. According to NICE, a surgeon is inexperienced if they have done the operation fewer than 20 times.
NICE recommends that keyhole surgery should always be considered if the hernia has been repaired before and comes back. This is known as a recurrent hernia.
Keyhole surgery is especially useful if your surgeon is not sure what type of hernia you have.
