Hernia surgery

In an abdominal wall hernia (also called abdominal wall hernia), intestines push through a weak spot in the abdominal wall. An abdominal wall hernia can have various causes. Weakened abdominal wall muscles or connective tissue weakness play a role, as does increased pressure inside the abdomen. This can be caused by heavy carrying and lifting, chronic coughing and sneezing or strenuous pressing during bowel movements and by being overweight. All of these occasions then create additional pressure on the abdominal wall, which can lead to a hernia in the abdominal wall in the long term. A bulge then forms that can be seen and felt from the outside, e.g. in the groin or at the navel.

However, there are also congenital abdominal wall hernias, especially in the area of the groin and the navel. Incidentally, the umbilical hernia (also called umbilical hernia) of the infant is the only type of hernia that can heal spontaneously, i.e. without surgery. The three most common types of abdominal wall hernias are:

Inguinal hernia
A natural weak point of the abdominal wall is located in the inguinal canal. The vas deferens and blood vessels for the testicle pass through this canal in men, and the round uterine ligament in women. About 25% of men and 3% of women develop an inguinal hernia during their lifetime. According to estimates, about 20 million inguinal hernias were operated on worldwide in 2008. In Germany, between 250 and 300,000 inguinal hernias (exact numbers do not exist) are currently operated on. Inguinal hernia surgery (also known as inguinal hernia) is the most common general surgical operation ever performed on men.
Umbilical hernia
An umbilical hernia, also called an umbilical hernia or umbilical hernia, occurs in the area of the belly button. It may be congenital or develop over the course of a lifetime. Often, an umbilical hernia can occur after pregnancy.
Incisional hernia
Incisional hernias (also called incisional hernia) occur exclusively in the area of previous surgery. This type of hernia can affect people of any age and gender. The scar is a weak spot where a hernia can develop even many years after surgery.

An abdominal wall hernia initially has no negative effects. Only pulling sensations occur. Later, a protrusion becomes noticeable. If the hernia is not treated, it enlarges over time and can then even lead to the entrapment of a loop of intestine. If it is not possible to push back the trapped loop of intestine and the blood supply to this loop is interrupted, this is a very painful and life-threatening condition that requires immediate surgery. One should not let it get that far.

An abdominal wall hernia never heals on its own. The only exception is the umbilical hernia of the infant. Hernia bandages (also called hernia bandages) are not a recommendable alternative to surgery – on the contrary: If the hernia is not operated on, the hernia gap widens and the already mentioned critical situation can occur. Therefore, abdominal wall hernias should be operated soon after diagnosis. All the more so, as hernia surgery carries minimal risk. In open inguinal hernia surgery (inguinal hernia surgery), the mortality rate in Germany is zero percent.

An abdominal wall hernia can be sutured with surgical sutures. This is known as the classic procedure. The alternative is to repair the hernia with a plastic mesh, the so-called tension-free procedure.

In the classic procedure, the protruding tissue is pushed back and the hernia gap is closed with a suture. With this procedure, tension can occur at the suture, which on the one hand causes more pain after the surgery, and on the other hand increases the risk that the tissue will tear again and a new hernia will develop at the same site.

In the tension-free procedure, the surgery procedure is similar in principle. However, the hernia gap is closed with a well-tolerated, flexible and flat or plug-shaped mesh. These meshes, made of special plastic, have been used successfully in surgery for almost 50 years and result in no or minimal suture tension.

In addition to the two procedures for closing the hernia gap, there are two fundamentally different surgical techniques. In both procedures, a mesh is generally inserted into the body, thereby repairing the hernia. In the open technique, the surgery is performed at the site of the hernia through a skin incision. In the endoscopic or keyhole technique, the surgical instruments are inserted into the abdominal cavity (the abdominal wall) through guide sleeves. This requires several, small incisions at the navel and in the lower abdomen.

The discomfort after a modern, i.e. usually outpatient, hernia surgery is minimal. The normal performance of the patient is quickly restored. Only 2 – 3 weeks after a hernia surgery (inguinal hernia surgery) you should take it easy. From the 4th, at the latest 5th week, you are physically able to work normally again. This also applies to heavy lifting and carrying.

The long-term success of the surgery is measured by the rate of recurrence of hernias. With the use of modern mesh materials and tension-free surgical techniques, this rate is very low. In specialized centers, it is less than 1% for inguinal and umbilical hernias. Incisional hernias are an independent clinical picture. Surgery is performed in pre-operated and thus weakened tissue. The success rates are therefore generally lower for incisional hernias.

  • By obligating the procedure and orientate on the findings of the respective patient
  • and by applying the modern surgical methods

In doing so, we prefer the open approach for fundamental considerations. Our reasons for this are:

  • Keyhole surgery more often carries the risk of potentially threatening complications (intestinal injury, injury to major blood vessel).
  • Advantages of keyhole surgery for the patient are only measurable in the first week after the procedure in a slightly better quality of life. However, this is contrasted by the pronounced satisfaction and lack of pain of our own patients directly after surgery.
  • Keyhole surgery is technically complex and cost-intensive. Why choose the complicated and expensive route when the same goal can be achieved more simply and thus with fewer complications?
  • However, the decisive factor for the success of a hernia surgery is not the type of method or technique used, but only the skill and experience of your surgeon.

Sources: (1) Peitgen K: Trends in minimally invasive hernia surgery. Ambul. Chirurgie 2009;2:31-38, (2) Gerhardus A et al: Vergleich verschiedener chirurgischer Verfahren zur elektiven Leistenhernienoperation bei Erwachsenen – Health Technology Assessment im Auftrag des Bundesministeriums für Gesundheit und Soziale Sicherung 2003;30, (3) Excerpts from flyer Fa. ETHICON “Diagnose Nabel- und Narbenbrüche” und “Leistenbrüche – Das sollten Sie wissen”, (4) Own text.