Hernia

A hernia is the exit of intestines from the abdominal cavity, either due to a congenital or acquired gap in the abdominal wall.

The contents of the hernia may consist of intestinal loops or other tissue from the abdominal cavity, but can also just contain some liquid. The protrusion always has a hernia sac that is formed by the peritoneum. The actual opening in the abdominal wall is called a hernia gap or hernial orifice. If the hernial orifice is narrow, the contents of the hernia sac may become jammed in the hernial orifice, which is referred to as an incarcerated hernia. This condition frequently causes severe pain. An incarcerated hernia is a medical emergency, as the blood supply to the incarcerated tissue is disrupted and the tissue may necrotise. Such an occurrence must be diagnosed quickly and surgical treatment in hospital must be initiated.

I will advise you on how an existing hernia can be closed and whether there is a risk of incarceration. If an operation is necessary, I will perform it safely and in a competent way.

Further information

Inguinal hernia

An inguinal hernia is a protrusion of the peritoneum with tissue/organs from the abdominal cavity through a gap in the abdominal wall in the groin area. An inguinal hernia should be operated on in time, as it bears the potential risk of incarceration including necrosis of sections of the intestine, causing a life-threatening situation.

Usually, an inguinal hernia can be felt as a bulge in the groin area. The hernia can be palpated better with the patient standing instead of lying, typically when coughing. A clear-cut diagnosis, the type and the extent of the inguinal hernia are determined in a clinical examination. In some cases, particularly with small hernias, an additional ultrasound examination of the groin is performed.

Treatment

An inguinal hernia is treated by surgically closing the hernial orifice. In this operation the inguinal canal is exposed, the contents of the hernia are placed back into the abdominal cavity, the hernia sac is removed and tightly stitched at the base, and the hernia ring is closed by sutures. To avoid the recurrence of inguinal hernia, reinforcing the abdominal wall in the inguinal canal area is of extreme importance. In the past, this used to be achieved by several layers of suture lines (Bassini and Shouldice technique). Today, the abdominal wall is strengthened by a synthetic mesh placed between the muscle and/or fascia layers in open surgery (Lichtenstein repair). Tension-free hernia repair is essential to prevent recurrence.

A similar principle is applied by a laparoscopic surgical method where a synthetic mesh that closes the hernia ring is placed between the peritoneum and the muscular abdominal wall via an access point into the abdominal cavity (Transabdominal Preperitoneal Hernioplasty, TAPP).

For a permanent closure of the hernial orifice in a unilateral inguinal hernia occurring for the first time, both surgical methods (open or laparoscopic) are equally suitable. In bilateral or recurring hernias, the laparoscopic TAPP method is recommended.

After a clinical examination I will inform you about the extent of the hernia and its appropriate treatment. I will advise you as to the operation method best suited to you and perform the surgery in a competent way.

Incisional hernia

Incisional hernia (hernia cicatricea) is a breaking of the connective tissue scar of a former surgical wound. This results in a fracture gap in the muscle connective tissue through that tissue and organs (intestines) from the abdominal cavity may emerge.

An incisional hernia should be operated in time, given the risk of entrapment (incarceration) with death of intestinal parts.

Mostly an incisional hernia is seen as a palpable bulge in the abdominal wall. The definitive diagnosis and the extent of scar rupture can be found during clinical examination and ultrasound.

Treatment

During surgery, the hernia sac is exposed, its content is shifted back into the abdominal cavity, thereby letting the hernia sac as intact. A synthetic mesh is then placed between the muscle and connective tissue of the abdominal wall. In this way the hernia gap is closed and the recurrence prevented by the tension-free implanted mesh (open sublay technique).

The choice of the surgical technique will depend on various factors. Tension-free closure of the hernia is important to prevent from a recurrence. I will advise you regarding the appropriate surgical procedure for the individual situation and perform the operation with competence and care.

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