Priv.-Doz. Dr. med. Joachim Conze is a leading specialist in the field of hernia surgery, heads the UM Hernia Center Dr. Conze in Munich, and also serves as a board member of the German Hernia Society. With over 30 years of experience—particularly in the treatment of inguinal and abdominal wall hernias—he enjoys a stellar reputation both nationally and internationally. Dr. Conze is renowned for his innovative treatment methods and his ability to develop tailored therapies for complex hernia cases. He has independently led the Hernia Center since 2017, offering comprehensive surgical solutions for a wide range of hernias, including inguinal hernias, umbilical and incisional hernias, sports hernias, and chronic groin pain.
A key focus is on personalized patient care. After a thorough examination, a specific treatment plan is created for each patient. The decision regarding whether surgery is necessary and whether a synthetic mesh should be used is made in close coordination with the patient, taking into account their individual risk profile. Dr. Conze favors open surgical techniques, which allow for intraoperative decisions on mesh use based on the patient’s needs—known as intraoperative “mesh tailoring.”
In addition to surgical hernia treatment, another specialty is managing chronic groin pain, often the result of earlier procedures involving mesh implants. Dr. Conze uses cutting-edge techniques such as intraoperative nerve response testing (IONR) to precisely locate and address pain. For elite athletes, the Hernia Center offers a specialized, mesh-free “Minimal‑Repair Technique” to treat sports hernias, which has gained worldwide recognition. Most procedures are performed under local anesthesia to minimize patient burden and can be carried out on an outpatient basis at the Hernia Center or in cooperation with the Paracelsus Clinic in Munich.
Dr. Conze’s expertise, his individualized treatment approach, and his commitment to patient‑centered solutions have made him one of Europe’s leading hernia surgeons. The editorial team of the Leading Medicine Guide had the opportunity to learn more from Dr. Conze in an in‑depth interview covering the breadth of hernia surgery.
Hernias occur due to a weakness or gap in the abdominal wall, allowing internal organs—such as parts of the intestine—to protrude. These weaknesses may be congenital or may develop over time due to factors such as obesity, heavy physical strain, or previous surgeries. Common types include inguinal hernias, umbilical hernias, and incisional hernias. Symptoms may include swelling and pain in the affected area, particularly during physical activity. Treatment options range from conservative therapies—like wearing a hernia belt—to surgical interventions.
Hernia Surgery: Open vs. Minimally Invasive Techniques
“There has long been a sort of ‘battle’ between surgeons who prefer open surgery and those who favor laparoscopic approaches. Ideally, surgeons should be skilled in both. Personally, I believe that someone who knits doesn’t necessarily have to crochet—and vice versa. Each surgeon develops a preference based on their experience. That’s why ongoing training, critical evaluation of techniques, and quality assurance are so important,” emphasizes Dr. Conze at the start of our conversation, before detailing the options of laparoscopy versus open hernia repair:
“While I performed many laparoscopic procedures in the past, I now operate exclusively via open surgery, because I believe others achieve better results laparoscopically than I can. I chose the open technique primarily because I feel it is often the better choice for many patients. It’s often claimed that laparoscopy is less taxing for obese patients. However, when a patient has a strong abdominal wall, closing the fascial defect after removing the trocars can be challenging, leading to trocar-site hernias. So, you may have repaired the inguinal hernia well, but a new hernia might form. Guidelines recommend a laparoscopic approach for recurrent hernias after previous external surgery since it avoids dissecting through scar tissue. I remain skeptical, as it’s often unclear whether the patient’s pain originates from the recurrence or from local irritation, like nerve injury. If a nerve is the problem, laparoscopic techniques usually cannot resolve it. Thus, I personally rarely see an indication for a minimally invasive approach. And if a patient specifically requests it, they should seek out a surgeon who truly specializes in those techniques—because complications are more common than people realize.”
The Herniamed Registry is a comprehensive database designed to document hernia operations. It allows the collection and analysis of patient data, treatment methods, and outcomes to improve care quality and advance scientific understanding. Surgeons use the registry to compare results and develop best‑practice methods. It supports ongoing improvements in hernia surgery and provides an evidence‑based foundation for clinical decisions.
“For over ten years, we have been systematically collecting data on hernia patients in this registry. We observe that about 12% of patients still experience pain one year after laparoscopic surgery, and one in ten requires a second operation. That really calls the quality of our outcomes into question,” criticizes Dr. Conze.
Suture or Mesh?
There are three primary techniques in hernia surgery: open and laparoscopic methods, with open procedures further subdivided into suture (tissue repair) and mesh techniques. Open repair aims for anatomical reconstruction of the posterior wall—either using overlapping suture techniques (Shouldice procedure) or a mesh approach (Lichtenstein), where a mesh is placed to reinforce the repair. All laparoscopic procedures involve mesh repair, covering the defect rather than closing it directly.
“Open surgery—specifically suture repairs—has gotten a bad reputation because most data comes from the 1970s to 1990s, when all hernias were repaired this way. Today, we know that not every inguinal hernia is suitable for suture repair. These are particularly appropriate for lateral, often congenital defects. We differentiate between hernias near the internal inguinal ring, where the spermatic cord enters the canal, and those through the medial posterior wall. Lateral hernias, which are usually congenital, respond well to suture techniques, especially in younger patients. If the medial posterior wall is significantly weakened, a mesh makes more sense. Such differentiation is not always possible preoperatively, even with ultrasound. A benefit of open surgery is intraoperative flexibility—it allows the surgeon to choose between suture and mesh based on findings. In laparoscopic surgery, mesh use must be decided before the operation, and general anesthesia is always required. One must also remain aware that complications can occur, and laparoscopic hernia complications are often more difficult to treat,” notes Dr. Conze and adds critically:
“I also don’t understand why the same mesh size—15×10 cm—is used for everyone, regardless of age, size, or gender. I just can’t accept that standard. While it’s good that meshes are placed between the peritoneum and the abdominal wall, removing them—partially or entirely—can be extremely difficult if problems arise.”
Patients’ individual risk factors—age, preexisting conditions, and overall health—also play a major role in choosing the surgical approach and deciding between mesh or suture techniques.
These factors affect both the abdominal wall’s integrity and the risk of complications, driving the choice of optimal technique. “Older patients or those with weakened connective tissue are more prone to larger, more complex hernias. In these cases, mesh is often preferred since their own tissue may not be strong enough to repair the defect alone. Mesh provides extrinsic reinforcement and reduces tension, lowering recurrence risk. We see the opposite in infants, where a small suture is sufficient due to their excellent healing capacity. As age advances, blood circulation and fascial healing decline, so we more readily use mesh. Still, I follow the younger‑patient principle—deciding mesh or suture intraoperatively based on findings. If it’s a lateral, congenital hernia and the medial wall is sound, even in older patients I don’t see a mesh as mandatory. Decisions should be guided by the individual risk profile.” explains Dr. Conze.
To prevent potential complications—such as infection or chronic pain after hernia surgery—there are preventative measures and a comprehensive postoperative care plan in place.
“With laparoscopic techniques, I worry that everything is treated ‘one‑size‑fits‑all,’ which doesn’t suit every hernia, since cases and symptoms vary greatly. Hernias in women should be approached differently than in men. Acute pain in young men needs a more cautious approach than a long-standing bulge in older men. The greatest danger in unclear groin complaints is intervening too extensively, too soon. The right decision must be made preoperatively,” advises Dr. Conze, adding further details:
“In the first few days post‑laparoscopy, recovery is generally smoother, while open‑surgery patients may take slightly longer to heal. From day three on, recovery is typically similar. We must also consider anesthesia: all minimally invasive procedures require general anesthesia, while all open procedures can be done under local anesthesia, optionally with light sedation. I am not a fan of spinal anesthesia—it’s quite invasive and often delays mobility and causes urinary retention. My patients walk to the operating table, undergo the procedure, and can be picked up about an hour later. At home, they can apply cold compresses and receive preventive analgesia. It’s important they don’t wait until pain sets in before taking medication. I like to think of myself as a ‘travel companion’ guiding patients through hernia repair, explaining the anatomy and planned procedure, with a focus on the postoperative course. An informed patient copes much better overall.”
For the past 13 years, Priv.-Doz. Dr. Conze has performed approximately 450–500 hernia surgeries annually (inguinal, incisional, and abdominal wall hernias) at the Hernia Center Munich. Every patient receives one-on-one care, with Dr. Conze personally seeing them before, during, and after surgery.
Regarding postoperative care, Dr. Conze adds: “I see my postoperative patients again on day 5 or 6 for follow-up and routinely perform an ultrasound on all of them—not just to check the superficial wound state, but also to exclude possible fluid collections (seromas) deep inside,” Dr. Conze explains.
Precision and Pain Management in Hernia Surgery: Advantages of the Open Technique.
“As I mentioned earlier, complication management begins with careful indication before surgery. The success of hernia repair is then ensured through a meticulous, standardized surgical technique. This is where the open technique stands out. It allows intraoperative assessment of sensitive nerve pathways, which can be spared or treated accordingly— and all this under local anesthesia! While it may not be considered minimally invasive, I view our method as ‘minimally traumatic.’ Because with local anesthesia plus light sedation, there's lower anesthetic risk, a small cosmetically unobtrusive 5 cm incision in the lower abdominal skin fold, no risk of trocar-site hernias, and often no need for synthetic mesh. The old advice to avoid lifting more than five kilograms postoperatively doesn't hold much weight nowadays— even a sneeze places more stress on the repair than light physical activity. The only limiting factor is pain, mainly in the first two to three days. After the first week, most patients have overcome the ordeal.”
“What I find striking is the high number of chronic pain patients who come to our Center. Someone with chronic groin pain, whether after open or laparoscopic surgery, often finds themselves without a solution, as the original surgeon may declare everything normal and no one else wants to intervene. I see patients from all over the country—sometimes young, strong men who are exhausted and in severe pain, often after a long journey through the medical system. Nearly 20% of my work now involves so‑called ‘cleanup procedures.’ When further surgery is necessary, it's especially elegant to perform it under local anesthesia. If I suspect a sensitive nerve is causing the pain, I can conduct an intraoperative pain response test. While operating in the scarred area around the nerve, I can partially awaken the patient, use forceps to manipulate structures, locate the nerve in the scar tissue, and treat it selectively. This is only possible under local anesthesia— unfortunately not favored by our healthcare system, since reimbursement for local anesthesia is significantly lower than for general anesthesia. But the sad issue of financial reimbursement in hernia surgery is another topic entirely.” And with that, we concluded our conversation.
Our heartfelt thanks to Dr. Conze for this thorough and highly critical exposition in the field of hernia surgery!
