Dr. Enrico Pöschmann is a recognized specialist in hernia surgery and runs the state-of-the-art Seechirurgie outpatient surgery center on Lake Zurich in Switzerland. With his many years of experience and expertise, he has built up an excellent reputation, particularly in the treatment of complex hernias such as incisional hernias, rectus diastases and sports hernias. Dr. Pöschmann performs around 500 operations in this area every year and specializes in minimally invasive procedures and robot-assisted surgery. These innovative techniques make it possible to carry out operations particularly gently, precisely and with minimal risk to the patient.
The Seechirurgie Center combines Dr. Pöschmann's expertise in his team with state-of-the-art infrastructure that ensures optimal patient care. With first-class equipment, including a high-end double operating theater, MRI and CT, the center offers advanced medical care. Close networking with external radiology institutes and regional GPs ensures precise diagnostics and seamless care. Particularly noteworthy is the focus on minimally invasive procedures, which are complemented by innovative keyhole surgery and the use of the Da Vinci robot. These advanced methods contribute to a faster recovery and a quick return to everyday life for patients.
Dr. Pöschmann attaches great importance to individualized surgery tailored to the specific needs of patients. Through his close collaboration with renowned hospitals and practice groups, as well as his continuous participation in international medical exchange, he always remains at the cutting edge of science. This enables him to integrate the latest diagnostic and surgical methods into his work, further consolidating his outstanding position in the international specialist community. In addition to his expertise in hernia surgery, Dr. Pöschmann is also highly skilled in the treatment of difficult adhesions, intestinal obstructions and other surgical procedures and is regularly asked for second opinions.
The Seechirurgie Center is characterized not only by medical excellence, but also by a pleasant and calming atmosphere that promotes the well-being of patients. This patient-oriented approach ensures that patients feel well looked after from the first consultation to aftercare.
The outpatientization of many treatments is picking up speed. The editorial team of the Leading Medicine Guide spoke to Dr. Pöschmann about this topic in particular, also with regard to outpatient hernia surgery.
Outpatient surgery is becoming increasingly important and is changing the way surgical procedures are performed. This trend is not only a response to many patients' desire for faster recovery and fewer hospital stays, but also the result of technological advances and innovative surgical methods. Especially in the field of hernia surgery, where operations traditionally required a longer hospital stay, outpatient operations are on the rise. Thanks to minimally invasive procedures and state-of-the-art technology, patients can now often go home after just a few hours without having to compromise on the high quality of treatment. Outpatient hernia surgery is an outstanding example of the efficiency and patient-friendliness of modern medicine. The Competence Centre for Lake Surgery, under the direction of Dr. Enrico Pöschmann, combines specialized surgery, emergency care and outpatient procedures.
The decision as to whether an operation should be performed on an outpatient or inpatient basis depends on various factors.
“In principle, many things are possible in our practice - but always after careful individual consideration. Certain procedures are clearly intended to be performed on an outpatient basis according to the specifications, under the principle of 'outpatient before inpatient'. There are also operations that can be performed on an outpatient or inpatient basis. In these cases, the patient's wishes and personal situation play a central role. The decision as to whether an operation is feasible on an outpatient basis is always made by the treatment team on an individual basis - based on clear medical criteria. These include the following questions: How complex is the procedure? What discomfort and risks can be expected postoperatively, for example in terms of pain or possible post-operative bleeding? The personal living situation also plays an important role: Does the patient live alone? Is adequate care guaranteed at home? Is there a long journey to the clinic? The decision is made by the interdisciplinary team, which also includes the anesthetist. Before the procedure, the anesthetist checks whether the patient is suitable for outpatient surgery from an anesthesiological point of view. In this way, we ensure that every procedure is carried out with the greatest possible safety and in the best interests of the patient,” explains Prof. Dr. Pöschmann at the beginning of our conversation.
Some people feel safer staying in hospital after major surgery, especially if they need support in their daily lives or the procedure involves a longer recovery period. In such cases, the decision to admit a patient to hospital may also be based on the patient's individual needs and safety. Whether outpatient surgery is an option depends largely on the patient's general state of health.
“If someone suffers from poorly controlled blood pressure, has a serious heart condition or is known to be prone to strokes, for example, they are classified as medically fragile. In such cases, it is advisable for safety reasons to perform the procedure as an inpatient under supervision. However, this decision is always made as a team - together with the anesthetist, the operating doctor and on the basis of all available information. We generally perform a lot of outpatient surgery in the practice, which works extremely well thanks to modern technology and well-established procedures. Another important criterion is the distance from the place of residence. A long journey can actually be an exclusion criterion for an outpatient operation - especially if the procedure takes place in the late afternoon. This is because the patient needs sufficient time to recover after the operation before they can be safely discharged home. The average length of stay after an outpatient operation is around one and a half to two hours. This mainly depends on how well the patient tolerates the anesthetic, whether nausea occurs and whether they are able to drink or eat again. The last outpatient operation of the day usually takes place at around 4 pm. We make sure that minor and uncomplicated operations on healthy patients are scheduled later. More complex procedures or operations on patients with relevant pre-existing conditions are performed as early in the day as possible. The anaesthesia department takes care of the scheduling in close coordination with the entire team - and this has proven to be very successful in daily practice,” says Dr. Pöschmann on the consideration of ‘outpatient or inpatient’.
Many operations can now be performed safely and efficiently on an outpatient basis - and this applies to far more than just minor procedures.
Dr. Pöschmann explains: “In our department, hernia operations in particular are standard and are usually performed on an outpatient basis. However, scheduled gallbladder removal for gallstones, provided there is no acute inflammation, and selected appendectomies can also be performed on an outpatient basis without any problems. All rectal surgery, i.e. procedures for haemorrhoids, fistulas or anal fissures, can also be performed very well in this setting. In addition, hand and foot surgery, knee joint arthroscopies and meniscus operations are also part of the outpatient spectrum. Minor bone fractures, for example to the wrist, fibula or metacarpus, as well as metal removal following bone fracture operations can also be treated on an outpatient basis. In addition to these surgical procedures, our practice also performs procedures from other specialties. Our gynaecological colleagues perform operations such as conizations or scrapings. In the urological field, we perform circumcisions, bladder irrigation and the insertion of ureteral stents. This range of services is supplemented by plastic surgery procedures such as eyelid lifts or breast operations, which are also performed on an outpatient basis. Overall, our close interdisciplinary collaboration with experienced attending physicians enables us to offer a wide range of surgical procedures that can be carried out on an outpatient basis in a gentle and patient-oriented manner."
Preparing a patient for outpatient surgery involves several steps aimed at making the procedure as safe as possible and promoting a speedy recovery.
Outpatient procedures are carefully planned in advance and are carried out in close coordination between the surgeon, anesthesia team and patient. As a rule, the operation can be performed within a few weeks of the initial contact. Medical care remains assured even after the operation - with clearly regulated availability of the medical team and supplementary digital solutions for monitoring the most important vital parameters.
“Before an outpatient operation is performed, detailed diagnostics and clarification are of course carried out directly on site. As a rule, the period between the first appointment and the operation is around two to four weeks - depending on the extent of the planned procedure and the urgency. In the case of acute complaints, it can of course also be quicker. Appointments are always made in close consultation with our anesthesia team and are also based on the patient's individual wishes, for example with regard to work commitments or vacation times. We always endeavor to make appointments as flexible and patient-friendly as possible. After the operation, it is important that the patient gets home safely. It is not permitted to drive independently due to the after-effects of the anesthetic. As a rule, patients arrange for relatives or friends to pick them up, or alternatively they can be transported home by cab or public transport. In the event that this is not possible, we also provide support in organizing transport. The following day, there is usually an initial follow-up check in an outpatient setting - here too, we provide the necessary support with the transfer if necessary,” says Dr. Pöschmann, emphasizing the importance of aftercare:
“We offer close and well-structured aftercare for the period following the operation. The responsible surgeon can also be contacted after the operation via an emergency number - around the clock, as can a member of the anesthesia team. This means that any complications such as pain, nausea or wound problems can be dealt with competently at any time. We are also currently working on an innovative aftercare concept in cooperation with a start-up: in future, patients will be equipped with a small monitoring system via an app that continuously monitors vital parameters such as heart rate or blood pressure. Any abnormalities are automatically evaluated by an AI and - depending on the severity - can be reported directly to the relevant doctors or, in an emergency, even to the emergency services. This system not only offers additional safety for patients, but also enables us to respond even better to individual risks in the future - even for patient groups with pre-existing conditions. Despite this technical support, one thing remains self-evident: the personal responsibility of the surgeons for their patients - even after the outpatient procedure - is beyond question for us."
Outpatient hernia surgery offers a number of advantages over traditional inpatient procedures, both for the patient and for the healthcare system.
Outpatient hernia surgery has developed significantly in recent years and now offers numerous advantages - both for patients and medical staff. While even simple, minimally invasive procedures such as a unilateral hernia operation used to result in a hospital stay of several days - sometimes from Monday to Saturday - this picture has changed fundamentally. Today, many patients can hardly understand why they should stay in hospital after an uncomplicated operation, as they are usually pain-free, mobile and without an infusion by the next morning.
“This development is mainly due to advances in surgical and anesthetic technology. The procedures are shorter, gentler on the tissue and cause significantly less pain than before. Outpatient surgery is now standard, particularly for uncomplicated inguinal or umbilical hernias. Outpatient procedures are also increasingly preferred from a health policy and insurance perspective. Patients welcome this development, as many no longer want to be admitted to hospital and actively ask for outpatient solutions. For the medical team, this development also means greater efficiency: organizational processes are more streamlined, ward rounds and lengthy inpatient processes are no longer necessary and communication can be more direct and targeted. In the outpatient setting, patients can also be cared for more easily between operations without having to maintain inpatient care. Outpatient hernia operations are usually performed using minimally invasive techniques, such as laparoscopic or robot-assisted surgery. In certain cases - such as young patients, smaller defects or special medical requirements - open surgery may also be appropriate, for example using the classic Shouldice technique without mesh implantation. These open procedures are also very gentle on the tissue and involve smaller skin incisions of around two to three centimetres, often even under local anaesthetic or in combination with a short anaesthetic,” explains Dr. Pöschmann.
As a rule, smaller and less complex types of hernia are particularly suitable for outpatient surgery, where the operation can be performed in a minimally invasive manner and the patient can quickly return to everyday life. These types include inguinal hernias, umbilical hernias and femoral hernias in particular, if they are diagnosed at an early stage and the procedure is planned accordingly.
The outpatient nature of procedures, particularly in the case of more complex hernia operations, poses a challenge in terms of the quality of aftercare and the rapid detection of potential complications. In order to ensure that patients receive optimal care despite not having to be observed in hospital, several measures are necessary that focus on both preventative aspects and comprehensive aftercare. These include close patient monitoring, modern communication channels and clear instructions for self-monitoring by patients.
“The introduction of the aforementioned app for digital aftercare is a promising step towards further improving safety and care after outpatient surgery. At the same time, however, the legitimate question arises as to how this system will work for older or technically inexperienced patients - for example, an 80-year-old woman who has difficulties with digital devices. In such cases, it is clear that patient safety comes first. If it is already foreseeable in advance that monitoring at home cannot be ensured - for example due to cognitive limitations or a lack of technical possibilities - the person concerned will not be scheduled for outpatient surgery. An inpatient stay is still appropriate and planned, particularly for older people with an increased risk or limited independence. The situation is different for patients who are cognitively fit and understand how to use the app or can be supported by relatives if necessary. In these cases, the digital follow-up system offers additional security without restricting care. Patients can recover in the familiar surroundings of their own home while being medically monitored by the team,” explains Dr. Pöschmann, explaining the options if the patient does need to be admitted to hospital:
“In the event that a patient still requires more intensive care temporarily after an outpatient procedure - for example due to nausea after anesthesia or severe pain - two additional patient rooms are available in the facility. These serve on the one hand as an extension of the day clinic capacity and on the other as a safety net for precisely such situations. These rooms are also used by attending plastic surgeons whose patients need to stay on site overnight after more complex procedures, for example in the breast area. In these cases, the respective surgeon takes responsibility for the care, which is medically secured - comparable to an 'in-house hotel' with specialist care”.
Although marine surgery is still a comparatively young project, it is already possible to look back - and this is very positive overall. The infrastructural foundations have been laid and have proven to be extremely efficient and reliable on a day-to-day basis, particularly on operation days.
“A medical system is never perfect - and that's a good thing. Because further development is a central component of medical quality. The team is constantly identifying and implementing small improvements, whether in process organization, communication or patient procedures. The aim is always to make processes even more efficient, make stays more pleasant and further increase safety. Particular attention is paid to the seamless transfer of information - because this is one of the most important foundations for high-quality medical care. To ensure this, internal processes are continuously reviewed and developed. In addition, the integration of new technologies is another important step. Increasing digitalization, for example through digital patient files, modern monitoring systems or smart aftercare solutions, is being used in a targeted manner to constantly modernize the care concept and adapt it to current standards. In short: there is no standstill. Marine surgery is a living system that is constantly adapting, improving and growing - always with the aim of offering patients the best possible outpatient surgical care,” Dr. Pöschmann makes clear and emphasizes at the end of our conversation:
“Another important aspect is our offer for attending physicians. In addition to specialized hernia surgery, we also offer other doctors who wish to perform outpatient surgery the complete infrastructure and the necessary support. This includes not only our modern operating theatres, but also the qualified staff and the anaesthesia and anaesthetic department. Our aim is to continuously develop and expand this service so that even more patients can benefit from this efficient and patient-friendly care. We currently perform around 50 to 60 operations per month. This number is likely to increase further, as we are still in the relatively early stages. However, the development is promising and we expect this number to increase further in the coming months."
Thank you very much, Dr. Pöschmann, for these encouraging descriptions of your outpatient operations at Seechirurgie!
