What is an incarcerated inguinal or femoral hernia?
In incarceration, the hernia contents cannot return to the abdominal cavity on their own and are compressed at the hernia neck.
The hernia sac may contain:
- loops of the small intestine
- the large intestine
- the omentum
- other intra-abdominal structures
Femoral hernias have a particularly high risk of incarceration because of their relatively narrow hernia neck.
Our approach
If incarceration is suspected, the patient is assessed urgently.
The following are assessed:
- the location of the hernia
- its size
- whether it can be reduced
- how long the symptoms have lasted
- the nature and intensity of the pain
- the presence of nausea and vomiting
- signs of bowel obstruction
- the condition of the skin over the hernia bulge
- signs of ischemia or necrosis of the hernia contents
When indicated, laboratory tests and *CT of the abdomen and pelvis* are performed.
When there are obvious signs of incarceration, examinations must not delay the necessary surgery.
When is urgent surgery needed?
Surgery is indicated for:
- an irreducible and painful hernia
- suspected incarceration
- worsening pain
- bowel obstruction
- signs of ischemia of the hernia contents
- suspected bowel necrosis
- peritonitis
- deterioration of the patient's general condition
An incarcerated inguinal or femoral hernia is an emergency.
How is the operation performed?
The operation is performed under general anesthesia.
The main stages are:
- access to the hernia sac and hernia neck
- careful release of the trapped organ
- assessment of its viability
- reduction of viable hernia contents
- if necessary, resection of a non-viable segment of bowel
- restoration of bowel continuity when indicated
- repair of the hernia defect
- repair of the inguinal canal or femoral ring
- placement of a mesh implant in suitable cases
The extent of the operation is determined depending on the condition of the hernia contents and local tissues.
Assessing bowel viability
One of the key stages of the operation is assessing the condition of the trapped bowel loop after the compression is relieved.
The following are assessed:
- the color of the bowel wall
- blood filling
- pulsation of the mesenteric vessels
- peristalsis
- other signs that the blood supply has been restored
If the bowel remains non-viable after the incarceration is relieved, it is resected.
Whenever possible, bowel continuity is restored by creating an anastomosis.
Laparoscopic treatment
In suitable patients, incarcerated inguinal and femoral hernias can be treated laparoscopically.
*TAPP (Transabdominal Preperitoneal)* can be used — an approach through the abdominal cavity with placement of a mesh implant in the preperitoneal space.
In selected cases, *TEP (Totally Extraperitoneal)* may be used — a totally extraperitoneal approach without entering the abdominal cavity.
The laparoscopic approach makes it possible to:
- assess the condition of the bowel
- determine the viability of the trapped loop
- reduce the hernia contents
- examine both groins
- repair the hernia defect
- place a mesh implant under suitable conditions
The choice of approach depends on the clinical situation, how long the hernia has been incarcerated, the condition of the bowel, the presence of peritonitis, and previous operations.
Bowel resection for an incarcerated hernia
If the trapped bowel loop shows signs of irreversible ischemia or necrosis, it is resected.
After the non-viable segment is removed:
- bowel continuity is restored when indicated
- the abdominal cavity is cleansed if necessary
- further repair of the hernia defect is decided based on the condition of the surgical field
In complex cases, the priority is to safely eliminate the life-threatening complication and control infection.
Repair of inguinal and femoral hernias
After the incarceration is relieved, the area of the hernia neck is reconstructed.
Depending on the clinical situation, the following may be used:
- repair with a mesh implant
- laparoscopic TAPP
- laparoscopic TEP
- open hernia repair techniques
- combined reconstructive techniques
For inguinal and femoral hernias, it is important to reinforce the entire myopectineal orifice and cover potential hernia sites.
Can a mesh be placed during incarceration?
In suitable cases, yes.
If the hernia contents are viable and the surgical field is not significantly contaminated, a mesh repair may be performed.
With bowel necrosis, perforation, peritonitis, or significant contamination of the surgical field, the decision on using a mesh is made individually.
The main priority in such cases is safe treatment of the acute complication and infection control.
Features of femoral hernias
Femoral hernias have a higher risk of incarceration because of the anatomy of the femoral ring.
During surgery, it is necessary not only to release the trapped contents but also to fully repair the femoral defect.
The laparoscopic approach allows the entire myopectineal orifice to be assessed and both the femoral and inguinal components to be repaired at the same time.
Advantages of timely treatment
- Rapid relief of incarceration
- Restoration of blood supply to viable bowel
- Prevention of necrosis and perforation
- Treatment of bowel obstruction
- The bowel can often be preserved with early surgery
- Repair of the hernia defect
- Lower risk of severe intra-abdominal complications
Recovery after surgery
The length of recovery depends on the complexity of the procedure.
After an uncomplicated repair, recovery is usually faster.
If bowel resection, cleansing of the abdominal cavity, or treatment of peritonitis was performed, the hospital stay and recovery may be longer.
After surgery, the following are provided:
- early mobilization
- pain control
- a gradual return to eating
- monitoring of bowel function
- prevention of thromboembolic complications
- wound care
- a gradual return to physical activity
Whenever possible, the principles of *ERAS (Enhanced Recovery After Surgery)* are applied.
Our advantages
- Emergency treatment of incarcerated inguinal and femoral hernias
- Laparoscopic TAPP and TEP techniques
- Assessment of bowel viability
- Bowel resection when indicated
- Treatment of complex and complicated hernias
- Modern mesh hernia repair techniques
- Minimally invasive reconstruction is possible
- Individual choice of surgical technique
- Modern postoperative care
Frequently Asked Questions
The strategy depends on the specific situation, but confirmed incarceration is an indication for urgent surgical assessment and, as a rule, surgery.
No. If the blood supply to the bowel is restored after the incarceration is relieved and there are no signs of irreversible damage, resection is not needed.
Yes. In suitable cases, TAPP or TEP can be used. Bowel necrosis, peritonitis, or a serious condition of the patient may require an open approach.
In suitable cases, yes. The decision depends on the condition of the bowel and the cleanliness of the surgical field.
Femoral hernias have a relatively narrow hernia neck, so the risk of incarceration and impaired blood supply to the hernia contents is higher.
Sudden or increasing pain, irreducibility or tenseness of the hernia, nausea, vomiting, bloating, and inability to pass gas or stool may indicate incarceration and require an urgent surgical assessment.