All reducible femoral hernias once diagnosed should be counselled for early surgery. There is no place for any conservative management of femoral hernia. Even if the patient has anesthetic risks it could be handled reasonably well under local anaesthesia with minimal sedation.
Underlying causes like bronchial asthma, constipation, prostatic hypertrophy, urethral obstruction etc will need to be handled simultaneously. Femoral hernia that are not reducible and with or without symptoms deserve immediate operative care. Because
of the anatomical tortuosity of the hernial sack, it is not easy to reduce a femoral hernia even under sedation. So it is not a good idea to seriously attempt reduction. It is better to prepare for emergency surgery. At surgery the hernial sac is opened,
edematous fluid removed and the contents examined for viability. If found viable, it could be returned back to the peritoneal cavity and the neck of the sac ligated. A special kind of hernial repair is undertaken wherein the Cooper's ligament is utilized for repair. This gives satisfactory results, particularly when the under lying causes are treated to prevent occurrences of other types of hernia or recurrence of a femoral hernia
- When patients exhibit signs of intestinal obstruction all hernial sites have to be examined including the femoral areas on both sides.
- When a small knuckle of intestine alone (Richter's Hernia) is present in the femoral hernia, one may not appreciate a palpable lump in the femoral area. But patient may have other signs and symptoms of intestinal obstruction.
- Although cough impulse is a clinical sign present in hernias it is very difficult to evaluate this in femoral hernia and it cannot be elicited in obstructed hernia.
- There is no place for any conservative management; abdominal truss is only of historical importance, no one uses it today.
- Precipitating causes for hernia like asthma, prostatic obstruction, constipation will all deserve evaluation, treatment and follow up to prevent formation of other hernias and recurrence of existing hernia.