In recent years, hernia surgery has contributed significantly to the positive development of modern healthcare, particularly with regard to visceral hernias and abdominal wall hernias. The possibilities within this discipline have expanded considerably thanks to minimally invasive procedures, the use of synthetic meshes, and advanced techniques such as keyhole surgery. A leading expert in this field is OA mag. dr. Jurij Gorjanc, dr. med., FRCS, FEBS AWS, who practices at the Klagenfurt Surgical Clinic. Dr. Gorjanc is a highly respected specialist in surgery and was admitted—as a non-British citizen—to the elite surgical association, the “Royal College of Surgeons of England.” He holds the title “Fellowship of the Royal Colleges of Surgeons” (FRCS), which signifies the highest level of surgical expertise and experience. Furthermore, as the long-standing president of the Slovenian Hernia Society, Dr. Gorjanc has made a significant contribution to the advancement of hernia surgery. In addition to his impressive academic career and international recognition, Dr. Gorjanc is distinguished by his humanitarian commitment. He has completed numerous volunteer medical missions in countries such as Tanzania, Madagascar, Ghana, and Mongolia to help patients with inguinal hernias. In Klagenfurt and far beyond, Dr. Gorjanc is regarded as a highly sought-after hernia specialist and holds the “Quality-Assured Hernia Surgery” seal from the German Hernia Society. With his extensive knowledge and experience in laparoscopic and open hernia surgery, he ensures successful procedures and positive outcomes in abdominal surgery. Dr. Gorjanc remains committed to the continuous advancement of hernia surgery and to upholding modern standards in medicine. The editorial team of the Leading Medicine Guide spoke with Dr. Gorjanc about the vital topic of hernia surgery and the current options and improvements available to patients.
Hernias are common medical conditions that can affect people of all ages. They occur when organs or tissues protrude from their normal position within the body cavity or through a natural opening into the surrounding area. Hernias can take various forms and occur in different parts of the body, and they often cause unpleasant symptoms such as pain, swelling, and discomfort. “A hernia develops wherever the tissue in the abdominal wall becomes too weak and gives way for some reason. A hernia can also be located inside the abdomen (internal hernia), such as in the case of a diaphragmatic hernia. The most common are external hernias, such as those in the groin in men (one in eight men suffers from them), incisional hernias, umbilical hernias, femoral hernias (more common in women), and many other types of hernias, including rarer forms,” explains Dr. Gorjanc at the beginning of our conversation to highlight the differences.
Inguinal hernia: This occurs in the groin area and can cause pain or visible swelling. Treatment is often surgical.
Ventral hernia: This occurs in the front abdominal wall and can lead to pain and tenderness. Treatment may be surgical.
Umbilical hernia: This occurs in the area of the navel and often appears as a visible bulge. Umbilical hernias are common in infants because the abdominal muscles are not yet fully developed at birth. In most cases, the hernia closes on its own as the child gets older. Treatment for an umbilical hernia may involve surgery, especially if it causes symptoms.
Femoral hernia: This occurs in the thigh region near the femoral artery and vein and can cause pain and swelling. Treatment is usually surgical.
Incisional hernia: This occurs at the site of a scar from a previous surgery and can cause pain and a visible bulge. Treatment may involve surgery.
Surgery plays a crucial role in the treatment of hernias, as it is the only effective method for permanently resolving this problem. Hernias do not go away on their own and often grow larger and potentially more dangerous over time.
One of the main concerns with hernias is the possibility that tissue or organs may become trapped within the hernia, which can lead to a life-threatening emergency. Surgery prevents this risk by closing the weak spot in the abdominal wall and returning the protruding tissue to its proper place. Hernias can also lead to complications such as inflammation, infection, or circulatory problems. Surgical treatment helps prevent these complications and protect the patient’s health. Hernias can be painful and significantly impair quality of life. Surgical removal of the hernia can relieve pain and enable the patient to return to an active lifestyle. There are various surgical techniques for hernia repair, including open hernia surgery and minimally invasive procedures such as laparoscopic surgery. The choice of technique depends on various factors, including the type of hernia and the patient’s individual needs.
“A hernia cannot be treated with medication; only surgery provides effective relief. Almost all patients with a hernia are suitable candidates for surgery. If general anesthesia is not possible, there is still the option of local anesthesia and/or conservative measures (without surgery). Guidelines are also important in hernia surgery; however, a hernia specialist should be proficient in as many surgical techniques as possible in order to offer the patient the best method. So today we’re talking about the next level in hernia care—not just guideline-based surgery, but individually tailored surgery that complies with surgical guidelines. Not every surgical technique is the best choice for every patient. At a certified hernia center, we ensure that this selection is optimized. Regarding risk, I can say that our recurrence rate for inguinal hernias is less than 1%, and the rate of chronic pain is also less than 1%. “These are two key metrics that play a role in hernia surgery,” said Dr. Gorjanc regarding successful hernia treatment methods.
Outpatient treatment offers various advantages to patients who need to undergo hernia surgery.
In an outpatient facility, patients can often go home the same day as their surgery. This enables a faster recovery, as the patient is in their familiar surroundings and can recover from the surgery in a comfortable environment. Outpatient treatments are generally more cost-effective than inpatient hospital stays. This can lead to lower healthcare costs for the patient. Since the patient goes home after surgery, the risk of hospital-acquired infections is lower. The home environment is often more hygienic and less prone to infections. Day surgery and outpatient procedures also offer patients convenience and flexibility. They do not have to spend several days in the hospital and can return to their normal activities more quickly. “For motivated patients who meet all the criteria, the benefits of day surgery are significant. The patient is actively involved from the start, which means they can mobilize and return to their daily activities more quickly, and their recovery time is shorter,” explains Dr. Gorjanc.
In day surgery centers, patients often receive more personalized care and attention, as they are not competing for resources with many other inpatients. A short hospital stay can be less stressful for patients, as they spend less time away from their responsibilities and families. A patient’s suitability for outpatient hernia surgery depends on various factors, which are evaluated on a case-by-case basis by the treating physician.
The type of hernia, its size, and its complexity are key factors. Smaller, less complex hernias are generally better suited for day surgery. The patient’s overall health is also of great importance. Patients with serious comorbidities or risk factors are less suitable for outpatient surgery. The surgical technique used and the planned procedure can also influence a patient’s suitability for outpatient surgery.
A certain amount of preparation and follow-up care is required for same-day hernia surgery.
The patient meets with their surgeon to discuss the need for surgery and to determine whether outpatient treatment is possible. The surgeon conducts a thorough health assessment to ensure that the patient is a suitable candidate for the procedure. This may include physical examinations, laboratory tests, and imaging studies. At the same time, the surgeon explains the risks, the procedure, and possible complications to the patient, and the patient provides written consent for the surgery. The patient then receives instructions on how to prepare for the surgery. These often include guidelines on eating and drinking, as well as medication instructions for the day of the surgery.
“Many factors play a role in the decision to opt for an outpatient facility. The distance from home, the patient’s mobility—they must not live alone—and several other factors come into play, such as body weight, hernia size, etc. Early mobilization after hernia surgery is desirable, but we always assess on a case-by-case basis whether postoperative care can be provided on an outpatient basis or not. “After a personal and detailed consultation, once patients feel they have received personalized advice and guidance, a surprisingly large number of patients agree to outpatient treatment,” says Dr. Gorjanc, affirming the procedure.
After surgery, the patient spends some time at the day surgery center or in the hospital to recover from the effects of anesthesia. The patient is closely monitored to ensure there are no complications and that they are recovering adequately. Upon discharge, the patient receives clear instructions for follow-up care, including pain management and behavioral recommendations. Responsibility for follow-up care lies with the patient and should be coordinated with the treating physician to ensure that no complications arise.
In hernia surgery, there have been several new techniques and advances aimed at shortening recovery time and reducing the risk of complications.
Laparoscopic or robot-assisted hernia surgery has become increasingly common in recent years. These techniques use small incisions and specialized instruments, which can result in less tissue trauma, smaller scars, less blood loss, and a faster recovery. “Minimally invasive procedures using open techniques (e.g., MILOS, eMILOS) can always be used; that is, the length of the skin incision is greatly reduced, leading to less postoperative pain. With less pain, patients are less afraid to move; otherwise, they always fear that ‘something might burst,’ which is actually almost never the case after a successful operation. And, of course, the laparoscopic technique of keyhole surgery must also be taken into account here. “Here, the trocars (medical instruments) are getting smaller and smaller, the synthetic meshes are becoming lighter, and the number of trocars is minimal, so all of this helps minimize the body’s postoperative inflammatory response as much as possible,” explains Dr. Gorjanc. For some minimally invasive hernia surgeries, local anesthesia can be used, which can speed up recovery since patients can be mobilized more quickly.
In addition, new meshes made from absorbable materials have been developed. These meshes break down in the body after they have fulfilled their function, and removal is not necessary. This can reduce the risk of foreign body reactions. Advances in pain management also make it possible to better control pain after surgery, which facilitates recovery. In many cases, patients who have undergone hernia surgery are encouraged to move around early and resume their normal activities quickly to speed up the healing process.
The long-term prognosis and quality of life for patients who have undergone hernia surgery are generally very positive, especially if the surgery is successful and the patient recovers well during the postoperative recovery phase. “The recovery process for outpatient procedures is the same as it is for inpatient treatment. We usually recommend up to 14 days of rest; after that, all physical activities are possible again,” Dr. Gorjanc concludes our conversation on an encouraging note.
Dear Dr. Gorjanc, thank you very much for this positive outlook on hernia surgery!
