Hernia Repair Surgery at the Sachsenhausen Clinic, Germany, Frankfurt

Hernia Repair Surgery

Hernia repair surgery is the most common surgical procedure available worldwide. Approximately 275,000 inguinal hernia operations and 100,000 operations for anterior abdominal muscle separation are performed in Germany every year. In these cases only surgery leads to the elimination of the disease. Several types of surgical interventions are possible. We use open inguinal incisions for cavity revision and laparoscopic methods of treatment. Depending on the technique, the surgical procedure can be recommended under local anesthesia or general anesthesia. No matter whether the defect is closed with a suture or with a suitable mesh insert, we discuss all options with the patient after a thorough individual examination. Our clinic is engaged in an online quality assurance program for hernia repair surgery, which improves patient care, provides reliable data for research in the field of health care and makes our work more transparent and effective. This is the reason why we are authorized to have the DHG seal "Hernia Removal Surgery of Guaranteed Quality".

Surgery for Inguinal and Femoral Hernias

With hernia protrusion, the defect of the abdominal wall does not close on its own, but becomes bigger and bigger. There is a risk that the intestinal loops will slip through the opening, which will result in pinching. This is an emergency condition and it is life-threatening to the patient. Therefore, there is always a ground for a surgical intervention. The appropriate type of surgery will be coordinated with the patient depending on the recommendations and the patient's individual state.

Possible Intervention Options

Open surgery:

  • Surgical intervention with a classic suturing technique (suturing is performed),
  • Zimmermann technique (suturing is performed),
  • Lichtenstein technique (the mesh plug technique),
  • Plasty with a transvaginal preperitoneal patch, for example, Pelissier technique (the mesh plug technique),
  • Fabricius or Lotheissen-McVay technique (suturing is performed on the hernia sac).

The following minimally invasive techniques are used:

  • TAPP – Transabdominal preperitoneal patch plasty.
  • TEP – Total extraperitoneal patch plasty.

Surgical Intervention for Umbilical Hernias

As in the case of an inguinal hernia, a fissure occurs in the area of the navel and the surgical procedure depends on many factors, such as the size of the hernia, the patient's physical state and age. Regardless of whether the operation is performed with a small incision (a few centimetres), as an open suture or mesh procedure or with the use of a minimally invasive technique (keyhole technique), we explain all the options for the intervention when consulting the patient.

Possible surgical treatment techniques:

  • PUMP – Preperitoneal umbilical mesh plasty (open technique),
  • IPOM – intraperitoneal Onlay mesh (laparoscopic technique),
  • Surgical intervention with suturing.

Surgery for Postoperative Hernia (Hernia at the Scar Area)

After any intervention in the abdominal area, there remains a scar, which is a weak spot in the abdominal wall. It may result in the occurrence of hernias in the area. A protrusion of the anterior abdominal wall, which includes intestinal loops, is formed. Any type of hernia should be treated surgically, or by using a minimally invasive technique or laparotomy. The method of surgical intervention is chosen depending on the patient's individual characteristics.

Possible methods of surgical intervention:

  • Open access with mesh attachment,
  • IPOM – intraperitoneal Onlay mesh (laparoscopic mesh),
  • Ramirez Separation Plasty (mesh overlap).

Recurrent Hernia

The recurrence of hernia sac formation requires a thorough medical examination, possibly with the use of a screening device. Then it is necessary to choose the most appropriate correction technique.

Parastomal Hernia

This type of hernia protrusion appears to be a complication after the implantation of an artificial intestine (abdominal cavity or anus). Several surgical procedures are available and they are individually adapted to the patient, taking into account his or her previous surgeries.

Hiatal Hernia

It is a diaphragmatic (axial) hernia which shows itself as an antireflux during acid burps – gastroesophageal reflux (GERD). It is diagnosed together with gastroenterologists, and as a result, the pathological reflux and pressure conditions are determined before the surgery. With this pathology, depending on the indications, a laparoscopic method of correction is used. You can find information concerning the treatment of gastroesophageal reflux on our website.

Inguinal hernia: short overview

A hernia (inguinal hernia) occurs when layers of the abdominal wall break through the inguinal canal. A typical symptom is a palpable swelling, similar to a bump that can often be pushed inwards. Also pain can occur, which increase under stress. In most cases, the patients are male. A hernia in women or girls is less common. The therapy usually consists of surgery.

Significant symptoms: visible and palpable swelling in the groin, pulling and possibly pain, which become stronger under stress

Cause: Weakness in the abdominal wall (innate or acquired)

Risk factors: severe pressure load (sneezing, coughing, pressing during bowel movements, lifting heavy loads, etc.), tissue weakness, diabetes mellitus, asthma, COPD, cystic fibrosis (cystic fibrosis)

Complications: entrapment

Treatment: usually surgery. In men with a hernia that shows no symptoms and does not increase, it is also possible to wait and see the hernia.

Inguinal hernia: symptoms

Even if the term suggests otherwise: In a hernia (inguinal hernia) no bone is broken, but it is pierced tissue in the groin - the so-called inguinal canal. This tubular connection between the abdominal cavity and the outer pubic region draws obliquely from back to front. In this channel run blood and lymph vessels and the spermatic cord in the man and one of the mother tapes in the woman.

If this inguinal canal is punctured by a hernia, this is recognized by a visible and / or palpable swelling in the groin, which can often be pushed inwards. Sometimes the genital region is also affected by inguinal hernia: In the case of a woman, the swelling can then occur in the area of the labia, in the man on the scrotum. In most cases, the inguinal hernia symptoms (woman & man) are on the right side.

Indirect and direct inguinal hernia

Most patients have an indirect inguinal hernia: here, the hernia sac occurs laterally through the inguinal canal and can penetrate to the scrotum or labia.

The indirect inguinal hernia is innate in most cases: it is then based on an incompletely closed inguinal canal. Normally, the inguinal canal is lined by the peritoneum until it returns to birth and usually closes completely until the end of the first year of life. If this does not happen, often a congenital indirect inguinal hernia arises. Babies, children and young people are the most affected, boys more often than girls. Rarely, an indirect hernia develops later in life (acquired indirect inguinal hernia).

In contrast, the direct inguinal hernia is always acquired. It arises from a weak spot in the wall of the inguinal canal. The fractured bag pushes directly through the abdominal wall, so it does not reach the genital region. Various factors can favor this wall weakness and thus the direct inguinal hernia (such as surgery or various diseases: see below). Mostly, adults develop this form of inguinal hernia. Women are relatively rarely affected. As a rule, the patients are older men.

Physical examination of inguinal hernia

In the physical exam, the doctor first asks the patient to stand straight. He then scans the groin region of the patient to detect any swelling. He may also instruct the patient to cough or contract the abdominal muscles, increasing abdominal pressure. This usually increases swelling in a hernia. The palpation examination can be repeated by the doctor while the patient is lying down.

It also checks whether the contents of the inguinal hernia can be pushed back into the abdomen with the fingers. If that works, there is a so-called repolarable inguinal hernia. If the doctor can push back the fracture contents but not the correct position, the inguinal hernia is irreponible.

To clarify a suspected inguinal hernia, a rectal examination may be necessary. The doctor scans the last piece of the rectum with a finger.

Ultrasound examination of inguinal hernia

If the physical examination is not sufficient to diagnose a hernia clearly, the doctor can examine the groin by means of ultrasound (lying and standing). So you can also judge how pronounced the inguinal hernia is and how urgent it must be treated. Especially in patients with severe overweight (obesity), an ultrasound examination or even magnetic resonance imaging (MRI) may be necessary.

Prof., Dr. med. Plamen Staikov

Prof., Dr. med. Plamen Staikov

Medical Director, Head physician

Holger Bahn

Holger Bahn

Senior physician

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