Senior Consultant Dr. Matthias Hofmann is a highly qualified specialist in general and visceral surgery with a distinct specialization in hernia surgery. Since 2019, he has been a senior physician at the Hernia Competence Center of Franziskus Hospital and has established himself as a respected specialist in hernia treatments at his practice in Vienna. As one of only four surgeons in Austria to successfully pass the Europe-wide recognized specialist examination FEBS AWS (Fellow of the European Board of Surgery in Abdominal Wall Surgery), Dr. Hofmann possesses exceptional expertise in reconstructive surgery for inguinal and abdominal wall hernias.
With over 845 successfully performed inguinal hernia operations and more than 400 abdominal wall hernia procedures, Dr. Hofmann has an impressive wealth of experience. He employs state-of-the-art, minimally invasive techniques that enable faster healing and fewer postoperative complaints. The surgical treatment of inguinal hernias in women and complex incisional hernias are particular areas of his focus. His patients benefit not only from his professional expertise but also from individually tailored, holistic care – from precise diagnostics and surgery to postoperative aftercare, which he personally oversees in his practice.
Dr. Hofmann places great emphasis on comprehensive consultation and preventive care for his patients, including prehabilitation before operations, which contributes to optimal preparation for surgical procedures. Gastric and colonoscopies for cancer prevention are also part of his service spectrum, making a significant contribution to the early detection and prevention of gastrointestinal diseases. Through his membership in renowned professional societies, such as the Austrian Society of Surgery (ÖGCH) and the German Hernia Society (DHG), as well as his work at Vienna's only certified Hernia Competence Center, Dr. Hofmann consistently stays up-to-date with the latest medical research and technology. Thanks to his many years of experience and profound specialized knowledge, he offers highly specialized and patient-oriented care that is valued in the region and beyond. The editors of the Leading Medicine Guide had the opportunity to speak with Dr. Hofmann and learn more about the focus of his work, particularly regarding inguinal hernias.
An inguinal hernia – medically known as Hernia inguinalis – is one of the most common surgical conditions. It occurs when tissue, usually a part of the intestine or fatty tissue, protrudes through a weak spot or opening in the abdominal wall in the groin area. This often manifests as a visible bulge and can be accompanied by pain or an uncomfortable feeling of pressure. Men are significantly more affected than women. If left untreated, an inguinal hernia can cause serious complications, which is why timely diagnosis and therapy, often in the form of surgery, are important. Modern surgical procedures today allow for gentle and safe interventions.
Among the most important factors that promote the development of an inguinal hernia is a congenital weakness of connective tissue. Especially in people with a family history, the tissue can give way more easily. In addition, mechanical stresses that increase pressure in the abdominal cavity contribute: heavy lifting, chronic coughing (e.g., in COPD or asthma), frequent and strong straining during bowel movements (e.g., in chronic constipation), or repeated vomiting are among them. Obesity, pregnancies, weak abdominal muscles, or previous surgeries that have impaired the stability of the abdominal wall are also risk factors.
“An inguinal hernia ultimately arises from a weakness of connective tissue. Various factors can promote this. One of the most important – and the only one that you can actively influence yourself – is smoking. Smoking damages connective tissue and significantly increases the risk of an inguinal hernia. So, quitting smoking is also an effective preventive measure. Besides that, there are of course causes that are less influenced, such as a genetic predisposition. If inguinal hernias have already occurred in the family, the risk of developing one yourself is also increased. Certain diseases, such as chronic obstructive pulmonary diseases, where there is a lot of strong coughing, also damage connective tissue in the long term and can promote an inguinal hernia. The same applies to people who do very hard physical work or engage in excessive strength training – the permanently high pressure on the abdominal wall also increases the risk here,” explains Dr. Hofmann at the beginning of our conversation.
Anatomical differences between the sexes, the often non-specific symptoms in women, and age-related tissue wear in men explain why inguinal hernias predominantly affect male patients. Diagnosis is often a challenge – especially in women – and worldwide, inguinal hernia is one of the most common surgical procedures.
“Why men are more frequently affected than women can be partly explained anatomically. While the inguinal canal is present in both sexes, in men, it develops into a continuous connection from the abdominal cavity to the scrotum – where the spermatic cord, with blood vessels and testes, runs. This structure is more susceptible to weaknesses. In women, however, the canal ends blindly and contains only the so-called round ligament, which serves to suspend the uterus. This means there are fewer opportunities for a hernia. Additionally, inguinal hernias in women are often more difficult to diagnose. The typical signs, such as a visible swelling in the groin, occur less frequently. Instead, many complain of unclear pain, which complicates the diagnosis. It often takes a long time before an inguinal hernia is even considered – many women have already undergone a series of other examinations by then. Often, an additional CT or ultrasound is then needed to find the cause. During pregnancy, the issue plays a subordinate role. The growing uterus protects the groin area as pregnancy progresses, acting as a kind of buffer that reduces pressure there. In women, inguinal hernias occur more frequently from about 50 years of age. Many have already had complaints for a longer time before the correct diagnosis is finally reached. In men, however, inguinal hernias are significantly more common – the ratio is approximately 10 to 1. It is one of the most frequently performed operations worldwide, with around 20 million procedures annually. One can say it is a kind of wear and tear phenomenon: connective tissue does not become more stable with increasing age, but weaker. And if the pressure in the abdominal region is high enough, this typical protrusion into the inguinal canal occurs,” says Dr. Hofmann.
In addition, smaller or deeper hernias in women are harder to feel during physical examination. Imaging techniques such as ultrasound or MRI are therefore more often used to confirm the diagnosis. Precisely because femoral hernias in women can become incarcerated more quickly and then represent a medical emergency, an early and exact diagnosis is particularly important. Therefore, in cases of unclear groin or lower abdominal complaints, hernias should be considered early on, even in women.
An inguinal hernia often runs with few symptoms for an extended period and may initially appear harmless. However, a hernia becomes an acute emergency if the hernia sac becomes incarcerated. In this case, intestinal loops or other tissue become trapped in the hernia gap, and blood circulation can be interrupted – a potentially life-threatening situation.
“If a patient comes to the practice with pain in the groin area, the first question is whether it is an emergency or not. In most cases, men have a so-called reducible inguinal hernia – a soft swelling in the groin, where parts of the abdominal cavity, such as fatty tissue or intestine, protrude through a weak point into the inguinal canal. However, this protrusion can usually be pushed back, so there is no acute danger. It is different if this hernia content – especially the intestine – becomes trapped and twisted in the inguinal canal. Then we speak of an incarcerated inguinal hernia, and that is a real emergency situation. Affected patients usually experience sudden, very severe pain, the swelling can no longer be pushed back and feels rock-hard. In such a case, immediate action is required because the blood supply to the trapped section of the intestine is disrupted. Surgery must be performed within a few hours to free the affected piece of intestine and avoid serious complications. In well-equipped regions like Germany, Austria, or Switzerland, this is usually not a problem – patients quickly get to the hospital, are operated on promptly, and everything proceeds in an orderly manner. However, it can become critical in countries or regions where adequate medical care is not guaranteed. If intervention is not timely in such a case, the situation can escalate dramatically: the blood supply to the intestine is completely interrupted, a hole forms in the intestine, stool leaks into the abdominal cavity, causing severe peritonitis. This can lead to sepsis and, if left untreated, even be fatal. For patients who do not need immediate surgery, the advice is to monitor the situation carefully and act immediately if certain warning signs appear. These include severe pain in the groin, a hardened swelling that cannot be pushed back – in these cases, emergency services should be called immediately and a hospital visited. Otherwise, one can certainly live with an inguinal hernia for some time without problems. Nevertheless, experience shows that about 70 percent of patients who initially opt against surgery return later – usually because the hernia grows larger and causes increasing discomfort,” Dr. Hofmann describes.
Acute Emergency in Inguinal Hernia
Important signs of an emergency include sudden, severe pain in the area of the hernia that does not subside even at rest. Additionally, the hernia site may be hard or tense, and the protrusion can no longer be pushed back – unlike an uncomplicated hernia. Accompanying symptoms may include nausea, vomiting, fever, a bloated abdomen, and increasing difficulty passing stool or gas. These symptoms indicate impending intestinal paralysis or bowel obstruction and require immediate medical attention!
Today, various modern surgical procedures are available for the treatment of inguinal hernias, which are fundamentally divided into open and minimally invasive techniques. The choice of method depends on several factors, such as the size of the hernia, individual patient risk factors, and also the patient's personal wishes.
Dr. Hofmann clarifies: “When it comes to surgery, there are fundamentally two proven procedures available: open surgery and minimally invasive techniques. Contrary to the common assumption that only minimally invasive surgery is performed, open repair with a synthetic mesh remains the gold standard. In this procedure, the inguinal canal is surgically opened, the mesh is inserted, and the wound is closed again. This procedure is still established and effective. Nevertheless, in recent years, minimally invasive methods have become increasingly popular – primarily because they are demonstrably associated with less postoperative pain and a shorter recovery time. There are two variants: In Germany, the extraperitoneal method is common, where the operation takes place outside the abdominal cavity. This is called TEP. In Austria, however, the transabdominal method, which goes through the abdominal cavity, is more frequently preferred – this is called TAPP. Both procedures place the mesh in the same position behind the peritoneum. This mesh is usually larger than that used in the open technique and thus covers potential hernia sites better. Especially for women, the minimally invasive technique should be preferred. This is because certain forms of hernia, such as femoral hernias, occur more frequently in women but often go undetected with the open method – unless specifically looked for. Minimally invasive techniques thus offer a diagnostic and therapeutic advantage here. There are also mesh-free procedures such as the so-called Shouldice technique, in which the hernia is closed with the body's own tissue. This procedure is an option in certain exceptional cases – for example, in young men, where an individual assessment can be made. As a rule, however, the insertion of a mesh is recommended, as it offers the lowest risk of hernia recurrence and chronic pain. Patients naturally have a say. If someone explicitly does not want a mesh, this is respected. In practice, however, this rarely occurs. In other regions, such as the USA, a critical attitude towards meshes is increasingly developing – partly, there is even talk of a genuine mesh phobia.”
Meshes used in the surgical repair of inguinal hernias are made of various synthetic polymers. There are numerous manufacturers, each with different materials and structures. The mesh remains permanently in the body and grows together with the surrounding tissue. The body's reaction to the material plays a central role: because the mesh is recognized as a foreign body, scar tissue forms around the mesh structure. This scar tissue is ultimately the decisive factor for the stability of the treated area – it supports the region more strongly than the mesh itself.
After an inguinal hernia operation, various risks and complications can occur, even if the procedures today are usually safe and routine.
“The overall risk of complications during an inguinal hernia operation is relatively low. As with any operation, there are general risks – such as those related to anesthesia or wound healing disorders – but serious problems rarely occur. Specifically for men, however, there is a particular risk: Since the procedure is performed in the immediate vicinity of the spermatic cord, injury can occur in rare cases. If the spermatic cord is severed on both sides, this would have the same effect as a vasectomy. Especially for younger men or those who wish to have children, this is an aspect that should definitely be considered beforehand. Another possible risk concerns the minimally invasive technique, which operates through the abdominal cavity. In theory, other organs such as the bladder or intestines could also be injured – although this is extremely rare. More common, however, is the occurrence of chronic pain after the procedure: about 7 to 10 percent of patients report persistent discomfort that lasts even six months after the operation. To avoid such complications as much as possible, the experience of the treating surgeon is a crucial factor. Studies clearly show that in specialized centers where inguinal hernias are operated on regularly, the risk of chronic pain and recurrence is only about 1 to 2 percent. In less experienced facilities, however, problems can occur in up to a quarter of cases. The choice of the right surgeon is therefore by no means secondary,” emphasizes Dr. Hofmann.
Dr. Matthias Hofmann has performed 1,007 inguinal hernia operations and 467 abdominal wall hernia operations in his medical career. (As of June 2025)
The return to daily life after an inguinal hernia operation depends on various factors, such as the type of procedure, the patient's general health, and individual healing processes.
After an inguinal hernia operation, recovery is usually uncomplicated and quick. The recommended resting period is comparatively short: during the first two to three weeks after the procedure, heavy lifting – meaning loads over five kilograms – should be avoided. After that, most everyday activities can be resumed. It is important to listen to your body and adjust to your personal discomfort: whatever causes pain should initially be avoided. Generally, the operated area can be subjected to stress again after a few weeks, so there is no increased risk.
Dr. Hofmann explains: “Especially among younger, physically active patients, the question often arises as to when they can resume training – for example, playing soccer. Here too, the rule applies: after two to three weeks, the body is usually stable enough again. Nevertheless, you should start slowly and gradually increase the intensity of exercise. Of course, one might ask what happens if someone lifts too heavily too soon. While it is theoretically possible that the inserted mesh could shift or be damaged due to overload, the materials used today are extremely stable. In the USA, for example, full weight-bearing is sometimes allowed as early as the first or second day after surgery – however, there are no secured scientific findings about the advantages or disadvantages of this approach. In German-speaking countries, aftercare tends to be more cautious. Special rehabilitation measures are not necessary after an inguinal hernia operation. As a rule, it is sufficient to adhere to the basic recommendations for rest,” and adds:
“Regarding medical care, experience is a crucial factor. In specialized centers like our Hernia Competence Center, over 1,300 hernia operations are performed annually – a number that is also high in European comparison. There, the entire treatment team, from the surgeon to anesthesia to nursing, focuses exclusively on these procedures. This specialization plays a decisive role in ensuring that patients receive the best possible care – with high safety and a low risk of complications.”
In Austria, the organization of surgical procedures is fundamentally regulated similarly to Germany: theoretically, any specialist may perform operations such as an inguinal hernia operation. However, this does not automatically mean that every intervention is performed with the same quality. This is precisely where the problem lies – and also the starting point for the discussion about specialization and centralization.
“The idea of having certain operations performed only in specialized centers makes perfect sense from a medical perspective. Because what you do frequently, you usually do better. This applies to surgery as well as to many other areas of life. Anyone who specializes in a particular field develops more routine, works more safely, and makes fewer mistakes. Ultimately, patients are the primary beneficiaries, as complication rates decrease and overall results are better. Nevertheless, it is still possible in Austria for any general surgeon to perform inguinal hernia operations – with very different results. The statement that 'anyone can operate on such a hernia' may be true on paper, but it does not necessarily reflect the reality in terms of quality and experience. Precisely because of this specialization, we are sought out by patients from all over the country. Some even travel from abroad – for example, from Dubai, Holland, or Norway. This clearly shows that many people specifically seek experience and competence when it comes to a surgical procedure,” clarifies Dr. Hofmann, and with that, we conclude our conversation.
Many thanks, Dr. Hofmann, for this insightful information!
