The most common operation in general surgery, and not only for us, is the treatment of hernia, which means the closure of:
- Inguinal hernias
- Umbilical hernias
- Abdominal wall hernias
We perform these procedures both in adults and in children.
Hernia is not a crack in the tissue. A hernia arises where the tissue becomes stretched in a weak point and a defect or a hole gradually forms. A hernia is almost never caused by an acute event, even if sometimes it gets noticed for the first time asuddenly after a stress.
The most frequent locations os hernias are the groin region, the navel, but also surgical scars. Here, the tissue is most likely to soften under constant stress such as heavy work, coughing, pressing, etc.
A hernia sac can usually be pushed back ("repositioned"), but in most cases the hernia occurs quickly again. However, the organs lying in the hernia sac, e.g. the intestines can start causing life-threatening emergency, because the blood flow through the intestine can be pinched off and an intestinal obstruction is formed. In order to prevent such an entrapment, an operation to close the hernial orifice is generally reasonable and necessary.
The hernial orifice can be closed using seams, plastic nets or the combination of both. It is almost always possible to perform the operation endoscopically, by means of laparoscopy. An "open access" is only necessary in particularly difficult situations (for example in the case of particularly large hernias or previous operations). For most umbilical hernias, a laparoscopy is “not worthwhile" because the small opening can be sewn through a mini-open access.
With plastic nets is the hernial orifice not only closed, but the weakened abdominal wall is reinforced. This significantly reduces the risk of recurrence (relapse) of the hernia compared to the simple seam, and the patients are allowed full weight-bearing already a few days after the operation. Large abdominal hernias started having prospects for a successful operation only since the introduction of the nets. Studies show, that endoscopic access minimizes the pain not only in the first days after surgery, but the risk of chronic pain, e.g. in the sensitive groins is significantly lower than in open access. After the operation on large abdominal wall hernias, sometimes pain occurs temporary at the attachment points of the net to the abdominal wall, which disappears as soon as the net firmly grows into the abdominal wall.
Thanks to the lack of pain and the early load bearing capacity one can return to work again after a short time.
The discharge is usually possible a few days after the operation, if not done ambulatory already. We recommend a few days' rest and if the pain in the wound (usually only minor) returns do only the "pain-adapted loading" according to the motto: "What does not hurt is allowed."
After the operation of large abdominal hernias, we prescribe to wear an elastic belly band not only to support the abdominal wall, which should be worn for 6 weeks, but recommend physical rest for 6-8 weeks ("safe is safe").
Inguinal hernias go through a canal in the abdominal wall, through which, in men, the blood-vessels runing to the testicle, or in women, a support ligaments of the uterus are situated. In men, this canal is bigger, therefore, 90% of this type of hernias occur in men. The hernia sac runs along the blood vessels going to the testicle, so it is clear that large inguinal hernias can spread to the scrotum. In an endoscopic operation, the hernia sac is pulled inwards and detached from the blood vessels of the testicle. Then, the soft plastic net is inserted into the space in front of the peritoneum, then fastened in a seamless way utilizing the pressure of the abdominal organs and quickly grows in. Hernias on both sides can be treated in one operation without additional cuts.
Particularly large inguinal hernias, adhesions after other operations or lack of anesthesia would be a reason for an "open" (= non-endoscopic) operation. An operation can be "open" and performed under spinal anesthesia. In this type of operation nets are also used (Lichtenstein technology) in order to take advantage of the opportunity to quickly return to normal way of life and the reinforcement of the abdominal wall.
Abdominal hernias usually develop near a surgical scar, which is always a weak point, but can also occur as a so-called epigastric hernia at the navel or above the navel.
In the first one, the two straight abdominal muscles in the upper abdomen are spread apart. This sometimes leads to an huge protrusion of the abdominal wall, but it is not a hernia, but a harmless standard variant of a protrusion of the abdominal wall. A rectus diastasis must therefore not be confused with a hernia!
Only small umbilical hernias can be closed by suture, in the case of larger hernias and in all incisional hernias, nets are used, which is usually done endoscopically.
Since the net is placed into the abdominal cavity, it has a special coating to avoid adhesions with the intestine. The net has to be fixed, which is done with absorbable "screws".
As the hernia sac is left, the cavity can fill with liquid which is absorbed gradually. This should not be confused with a new hernia ("relapse")!