Dr. med. Enrico Pöschmann is a recognized specialist in hernia surgery and successfully heads the Swiss Hernia Center, which has now merged with his Seechirurgie practice and opened its doors in October 2024 as the Seechirurgie Surgical Center and Outpatient Surgery Center. Dr Pöschmann and his experienced team cover the entire spectrum of hernia surgery and offer excellent diagnostics as well as innovative surgical procedures. Dr Pöschmann has extensive experience, particularly with complex hernias such as incisional hernias, rectus diastasis or sports hernias. Thanks to this expertise, the Swiss Hernia Center has been able to expand and now has locations in Schaffhausen, Schwyz and Zug. The center works closely with various renowned hospitals and medical practices.
Dr Pöschmann has earned an outstanding reputation in the surgery of abdominal wall hernias and diaphragmatic hernias. He is not only a master of minimally invasive keyhole surgery but also a leader in the application of robot-assisted surgical techniques (such as the da Vinci method). His wide repertoire of surgical procedures enables individually tailored interventions that significantly improve the chances of recovery and allow patients to return to their daily lives quickly. Dr Pöschmann brings his extensive expertise to bear particularly in cases of severe abdominal adhesions. In addition to using ultrasound technology, he also employs advanced methods such as CT or MRI scans where necessary to make a precise diagnosis.
Dr Pöschmann’s high level of expertise stems from many years of academic and clinical training. Even during his studies at the renowned University of Leipzig, he devoted himself to hernia surgery. He later deepened his knowledge in senior positions at several major hospitals and gained valuable experience as a consultant and health economist. Today, Dr Pöschmann is known not only for his surgical skills but also for his role as a managing director and consultant, where he contributes his expertise to the development of cooperation models and medical centers. The Swiss Hernia Center stands for the highest quality in hernia surgery, as evidenced, among other things, by its certification by the German Hernia Society and its participation in the international Herniamed network.
The editorial team at Leading Medicine Guide had the opportunity to speak with Dr Pöschmann and learnt more about hernia surgery.
Hernias, also known as intestinal hernias, occur when internal organs or tissues protrude through a weak spot or opening in the abdominal wall. They occur particularly frequently in the groin area, around the navel or at surgical scars and can affect people of all ages. Hernias often result from a combination of congenital or acquired weaknesses in the tissue and increased pressure in the abdominal cavity, such as when lifting heavy loads, suffering from chronic coughing or straining heavily. Although hernias are often painless and appear only as an external bulge, they can lead to serious complications such as strangulation, which requires immediate treatment. It is therefore important to detect hernias at an early stage and, depending on their type and size, to consider appropriate treatment options in order to minimize risks and improve the quality of life of those affected.
The symptoms of a hernia can vary depending on the type and location.
“A classic hernia, such as an inguinal hernia, manifests as a bulge in an area where there was previously none. Sometimes this becomes clearly visible, for example after a coughing fit or when lifting something heavy. In some cases, one may also feel localized pressure, a pulling sensation or even a stabbing pain. The symptoms are very varied,” begins Dr Pöschmann in our conversation. In advanced cases, when parts of the intestine become trapped by the hernia (incarceration), severe abdominal pain, nausea, vomiting and digestive problems such as constipation may occur, indicating a medical emergency. However, there are also hernias that are asymptomatic and are only discovered by chance.
Those affected should definitely consult a doctor if they experience the symptoms mentioned above. Regarding diagnosis, Dr Pöschmann explains: “The most important aspect of diagnosis is the medical history. This is because we need to find out what symptoms the patient has and for how long. I ask whether there was a specific trigger and whether there is a family history of the condition. A family history is particularly common in men when it comes to inguinal hernias. In women, there is sometimes a predisposition to generally weak connective tissue with insufficient protein. This is followed by a physical examination, during which we examine the area where the patient has noticed something unusual. Hernias can often be clearly felt by hand; one can frequently detect gaps or the hernial sac itself. In any case, it is possible to localize the area of the hernia. Then, in line with international standards, an ultrasound scan is performed, as this allows the findings to be assessed with complete accuracy. This confirms whether a hernia is present – a hole in the abdominal wall – and determines the size of the hernia; only then can a decision be made regarding treatment.”
If an incarcerated hernia is suspected, where tissue is trapped and blood flow is disrupted, a rapid diagnosis is crucial to prevent serious complications and, if necessary, to initiate emergency surgery.
The risk of developing a hernia increases with age, as tissue elasticity decreases. Men are more frequently affected, as the inguinal canal is anatomically more susceptible in men. Other risk factors include genetic predisposition, chronic cough, heavy lifting, obesity, pregnancy, chronic constipation and scar tissue from previous operations. Conditions such as Marfan or Ehlers-Danlos syndrome, genetic disorders that weaken connective tissue, can also increase the risk.
The best time for surgical treatment of a hernia depends on various factors, including the type of hernia, the severity of symptoms and the risk of complications.
“There are no conservative treatments for a hernia. If a patient cannot undergo surgery immediately, so-called hernia trusses (a type of support or compression aid) can be used temporarily, but this is definitely not a solution. This is because a hernia is a biomechanical problem – the hole that has formed in the abdominal wall must be closed surgically. Exactly when this is done depends primarily on the symptoms. This is because there are also small hernias that actually cause no symptoms at all, and in such cases the patient can be managed with ‘watchful waiting’. This means that the patient and the doctor monitor the condition closely. “As soon as noticeable symptoms become apparent – which can then be seen on an ultrasound scan – or if inflammation develops due to repeated strangulation, or if the bowel keeps pushing through, surgery is absolutely essential,” Dr Pöschmann makes clear.
Minimally invasive procedures, also known as laparoscopic surgery, offer a number of advantages over conventional open surgery in the treatment of hernias.
A key advantage of the minimally invasive method is the reduced trauma to the tissue. Instead of a large incision, the laparoscopic technique involves making only a series of small incisions through which instruments and a camera are inserted. This results in less post-operative pain and a faster recovery, which often allows for a shorter hospital stay. Patients can usually resume their normal activities sooner, and the cosmetic results are more aesthetically pleasing due to the smaller scars. The risk of wound infections is also generally lower with minimally invasive procedures.
Dr Pöschmann explains: “Almost all hernia operations can be performed using minimally invasive techniques – the question is simply whether it always makes sense. For example, if you have a very young male patient who is thought to have a hernia, but it isn’t actually a proper hernia at all; rather, the canal through which the testicle travels from the abdomen into the scrotum hasn’t closed properly. I wouldn’t treat something like that with a synthetic mesh, as would be required in a minimally invasive procedure. In this case, I would simply stabilize it with a small incision and a special suturing technique, which would then last for the rest of the patient’s life. The same applies to a young woman with a very small femoral hernia, where a mesh is not strictly necessary either. Here too, it is perfectly possible to operate from the outside using a small incision. For patients with a large incisional hernia, a minimally invasive procedure doesn’t make sense either. In this case, it’s better to reopen the old scar, stabilize everything properly and close it up again,” and he adds a comment on the use of meshes:
“With meshes, the gold standard is the use of polypropylene or Prolene meshes, which are permanent synthetic meshes that offer excellent stability, have very good healing rates and do not cause allergies. However, there may also be situations where patients have very small hernias that still need to be stabilized, in which case one tends to opt for a biodegradable mesh, which dissolves after 15–18 months and is replaced by the body’s own connective tissue. This is also a popular choice for patients who wish to return to sport quickly, simply because the biodegradable meshes, once they have broken down and been remodeled, help to restore the body’s natural elasticity. Then, of course, there are patients who simply do not want to have plastic in their bodies, for whom biodegradable meshes represent a good alternative. The only limitation we face here is that there is as yet no reliable long-term data (ten years or more) available. However, if these meshes are inserted correctly and the indication is appropriate, they appear to be extremely effective and in no way inferior to a synthetic mesh. What we do not yet know, however, is how the tissue regenerates after ten years or how stable it is once the mesh has dissolved. I am very happy to use biodegradable meshes and do so frequently; I was also the first to use them in Switzerland, have had very good results so far, and have not had a single recurrence since 2014.”
The risk of recurrence, i.e. the reappearance of a hernia after surgery, varies depending on the type of hernia, the surgical procedure chosen and the patient’s individual risk factors.
Recurrences may occur more frequently in cases of larger abdominal wall hernias or in patients with risk factors such as severe obesity, smoking or chronic cough. “Of course, it also depends on the location of the hernia, but if we take the most common type of hernia as an example—the inguinal hernia—then, according to global statistics, the recurrence rate is approximately 1.5–3%. We also need to distinguish here. Is it a recurrence because the mesh has torn, which is extremely rare, or because the patient has gained weight and the chosen mesh size is simply no longer sufficient? Technical errors do occur in some patients, for example, if meshes that are too small have been chosen. In the past, the shrinkage of meshes within the body was not always taken into account. I operate on recurrences every week, though the mesh does not always need to be replaced. After all, the mesh has integrated into the body over time, so I avoid replacement as much as possible and prefer to add a second mesh. I also always try to make a correction from the inside, which is possible in 90% of cases. As a general rule, if the patient underwent minimally invasive surgery for the first operation, the second operation is open, and vice versa. But minimally invasive surgery is simply much less traumatic for the patient. In such cases, I also like to use the robot-assisted approach, because it allows for even greater precision,” says Dr Pöschmann, describing his approach.
After an operation, it is important to ensure sufficient recovery time and to avoid activities that could lead to strain on the abdominal muscles. Gradually resuming physical activity and strengthening the abdominal muscles through targeted exercises can also help to stabilize the abdominal wall and minimize the risk of recurrence.
“With typical inguinal hernias, there are no special precautions the patient needs to take. Rest for 2–3 days is advisable to allow the wound to heal, and cycling should ideally be avoided for around two weeks, as this causes jarring movements in the groin. For all other major abdominal hernias, I am personally very strict, and my patients then wear an abdominal support for about six weeks, are not allowed to lift more than five kilos and must not do any sport. This, of course, has the disadvantage that muscle mass decreases. After the six weeks, I see the patient again and an ultrasound scan is carried out. If everything has healed well, intensive exercise therapy can begin, which is just as important as the operation. After all, strong muscles are always beneficial, even from a preventive perspective. Poor muscle tone combined with severe obesity is a bad combination. And as with all wounds, the issue of not smoking is important, as this always causes the blood vessels to constrict and less oxygen reaches the area where healing is supposed to take place, which in cases of doubt can lead to reduced stability of the implanted mesh,” recommends Dr Pöschmann.
The treatment of complex hernias such as incisional hernias and rectus diastasis presents particular challenges, as these conditions are often associated with larger defects in the abdominal wall, poorer tissue quality and an increased risk of complications.
Incisional hernias develop at the site of a previous operation and are often weakened by scar tissue, which makes healing more difficult and increases the risk of recurrence. Rectus diastasis, i.e. the separation of the rectus abdominis muscles, is not a classic hernia, but can cause similar symptoms and also significantly weaken the abdominal wall.
Rectus diastasis is a medical condition in which the two longitudinal muscles of the abdominal wall – the so-called rectus muscles or ‘six-pack muscles’ – move apart. This occurs due to overstretching of the connective tissue structure that connects the muscles along the midline of the abdomen, known as the linea alba. This condition leads to a weakening of the abdominal wall and can manifest as a visible or palpable gap along the midline of the abdomen, particularly when the abdominal muscles are tensed.
“In all complex and large hernias, in rectus diastases, where the abdominal muscles sometimes diverge by up to 20 cm, and in lateral hernias on the outer side of the abdominal wall. The latter sometimes arise following previous operations on the kidney or liver. These operations are very challenging and always require a so-called ‘tailored approach’, i.e. a bespoke treatment plan for each individual patient, which must be very carefully planned. In patients with very large hernias where the muscles are widely separated, pre-treatment is usually also necessary. There are several approaches, and different colleagues use different techniques. Personally, I switched to Botox treatment some time ago. In this procedure, patients receive ultrasound-guided Botox injections into the oblique abdominal muscles 4–6 weeks before the operation. This makes the entire abdomen extremely soft, as the oblique abdominal muscles no longer pull, and it is then possible to close these large hernias tension-free during the operation. “And tension-free closure is always what you want to achieve. Because wherever you pull tissue together with thick sutures, there are circulatory problems, which in turn prevent proper healing,” explains Dr Pöschmann.
Inguinal hernia surgery is one of the most common operations worldwide. Dr Pöschmann himself performs around 500 a year, and across the entire Swiss Hernia Center, around 1,000 operations are carried out annually.
The new outpatient surgical center “Seechirurgie”, headed by Dr Enrico Pöschmann on behalf of the Swiss Hernia Center, sets new standards in surgical care and is a merger of the Seechirurgie practice and the Swiss Hernia Center.
A modern practice center covering around 650 m² has been created, perfectly tailored to the needs of both patients and medical staff. The new facility features state-of-the-art examination rooms and a dual operating theater with two surgical stations. This layout enables the smooth performance of outpatient procedures and ensures efficient workflows thanks to short distances and a well-designed spatial structure. Particular attention has been paid to the flexibility of the practice infrastructure, enabling the surgical center to respond optimally to the changing needs of medical care. This is evident both in the technical equipment and in the operational processes, which are designed for needs-based use. Furthermore, great importance has been attached to the quality of the patient experience. The high-quality and stylish interior design creates a pleasant and calming atmosphere that benefits both patients and staff. ‘Seechirurgie’ combines state-of-the-art technology with a comfortable and patient-centered environment, making it a central hub for outpatient surgical treatments in the Zurich area.
“The shift toward outpatient care is continuing to advance, and the Seechirurgie Surgical Center – which remains the home of the Swiss Hernia Center – is perfectly equipped for this. Our patients are far less stressed and less traumatized. And here we can offer everything from a single source, including X-rays and digital ultrasound; we have fully integrated diagnostics with CT and MRI, with in-house radiologists, and can operate directly on site, including laparoscopic and arthroscopic procedures. We can perform major operations at our partner hospitals. There is also a close link with GPs and private practitioners in the local area, so that appointment scheduling is optimized. Seechirurgie is, incidentally, open to external surgeons!”, explains Dr Pöschmann, and with these positive developments we conclude our conversation.
Many thanks, Dr Pöschmann, for these fascinating insights into hernia surgery!
