Abdominal hernia surgery is the standard treatment for hernias of the abdominal wall.
A hernia of the abdominal wall does not heal by itself, even if in mild cases it is possible to push back the hernia sac so that the organs are back in their correct position. However, the risk of re-protrusion is then increased and the muscle gap can widen due to the pressure of a hernia sac.
This also increases the risk of complications without immediate abdominal wall hernia surgery. For example, parts of organs that have slipped out can be pinched off, leading to painful and dangerous circulatory problems. If part of the intestine is involved, there is a risk of life-threatening intestinal obstruction.
Timely surgery for an abdominal wall hernia prevents this risk. An obstruction can only be removed by emergency abdominal hernia surgery.
The peritoneum is the innermost layer of the abdominal wall. It covers the intestines, liver, stomach and spleen. The peritoneum secretes a secretion which, in simple terms, serves as a lubricant to prevent unpleasant friction when organs move against each other.
Doctors speak of a hernia of the abdominal wall when the peritoneum bulges outwards through a muscle gap. Organs can also slip outwards in this tissue sac (hernia sac). The standard treatment is an abdominal hernia operation.
Operations for abdominal wall hernias are so common because the abdominal wall is not evenly structured. A hernia usually occurs at an anatomical weak point, for example in the navel area. Hernias are more likely to form if the abdominal wall is not very firm, for example due to a congenital weakness in the connective tissue or decreasing tissue strength with age.
The trigger for the hernia and thus for the subsequent abdominal hernia operation is then usually an unusually high pressure in the abdominal cavity. This can be permanently increased by injuries, tumors or water retention, for example in the case of liver cirrhosis or chronic lung diseases. Or the pressure may increase temporarily when coughing, straining or lifting heavy objects. Being overweight is also an additional risk factor.
The situation is different for children who require surgery for an abdominal wall hernia. In these cases, the gap through which the peritoneum slips is usually congenital.
An abdominal wall hernia operation may also be necessary after previous surgery in this region of the body, as it is easier for a hernia to occur in the area of the scars. Patients should be particularly careful if the surgical wounds have become infected. Again,obesity is an additional risk factor.
Incidentally, hernias can also occur inside the body. They are rare and are always treated by abdominal hernia surgery.
The type of surgery for abdominal wall hernias also depends on where exactly the hernia has occurred. Hernias most frequently occur in the groin area, which are then referred to as inguinal hernias. Those affected are usually men because the testicles of the embryo push down through the inguinal canal and the canal then no longer closes completely in some cases. Most abdominal hernia operations are therefore performed in the groin area.
The femoral hernia, on the other hand, is more common in women. It occurs below the inguinal ligament.
Another typical hernia site is the area of the navel, known as the umbilical hernia. The purpose of an abdominal wall hernia operation here is also to support the abdominal wall in order to prevent future hernias. Umbilical hernias in children are a special case. This is the only form of hernia that can heal on its own within the first two years. Surgery can therefore be avoided in some cases.
A hernia in the upper abdomen(epigastric hernia), which is located between the breastbone and the navel, is much rarer. It is almost always repaired by abdominal hernia surgery.
An incisional hernia, on the other hand, can occur anywhere in the abdominal wall - depending on the position of the scar after a previous operation.
Small hernias are often barely noticed by those affected because the symptoms only become apparent under stress - and surgery is unknowingly delayed. For example, the patient experiences a feeling of pressure, which can turn into pulling or stabbing pain as soon as they tense their abdominal muscles. Typical situations are
Although an abdominal wall hernia operation is not absolutely necessary at this stage, a hernia does not disappear on its own, meaning that the condition is likely to worsen over time without treatment.
In addition, the mobility and therefore also the quality of life of those affected is restricted. They try to avoid painful situations - however, subsequent operations for abdominal wall hernias become more complex if the hernias enlarge.
If the gap grows, the pain remains permanent, the affected person feels ill, often suffers from problems with bowel movements and can even feel the hernia from the outside.
An abdominal wall hernia operation can now no longer be avoided. Otherwise, in the worst case scenario, organs can be pinched off and slip outwards through the hernia. This can lead to a life-threatening intestinal obstruction, for example. In this case, emergency surgery is indicated.
Doctors therefore recommend that abdominal hernia surgery should be performed early and planned in order to prevent this situation.
Experts only refrain from performing abdominal wall hernia surgery if the procedure itself would pose too high a risk for the patient. This is the case for chronically ill patients, for example. If, for example, the accumulation of water in liver cirrhosis has led to the hernia, doctors must consider whether they can expect the patient to undergo abdominal hernia surgery.
Here too, the decision for or against immediate surgery for abdominal wall hernias depends on how large the hernia is and where exactly it is located. In other words: How likely are life-threatening complications?
A comprehensive diagnosis is a matter of course before an abdominal hernia operation, among other things to determine the exact location of the hernia.
The physical examination begins in a standing position. The patient must cough or push while the doctor palpates and usually feels or even sees the hernia sac. The same examination is also carried out with the patient lying down.
Before the abdominal wall hernia operation, additional ultrasound images (sonography) are taken, which also show which organs may be located in the protrusion. In this way, the doctor also determines the urgency of the operation. The larger the hernia and the more organ parts that are exposed through the protrusion, the quicker the abdominal hernia operation must be performed.
In some cases, such as umbilical hernias or internal hernias, a computer tomography scan is also performed.
Abdominal wall hernia operations are among the most common procedures and can be performed without complicated preparations. The patient usually only has to come to the clinic on the day of the abdominal hernia operation, where blood is taken. Six to eight hours before the planned operation, the patient is not allowed to eat, drink or smoke.
An anesthesiologist will discuss with him which form of anesthesia will be chosen. Whether a general anesthetic is necessary or a local anesthetic is sufficient depends on the type of abdominal hernia operation.
In the case of general anesthesia, an ECG will also be performed beforehand. In either case, the patient is given sedative medication in advance. In addition, the respective body area is shaved before the abdominal wall hernia operation.
There are various procedures for abdominal wall hernia surgery.
Basically, the aim is to close the existing gap permanently by means of abdominal hernia surgery. Only in the case of small, uncomplicated hernias can this be done exclusively using sutures. In many cases, it is also necessary to use a plastic mesh during abdominal wall hernia surgery to stabilize the area in question. This is not only used for larger hernias, but also for older patients whose connective tissue is more flexible.
The mesh used must be significantly larger than the gap created so that it can fuse well with the body's own tissue.
Their position varies greatly:
The procedure chosen for abdominal hernia surgery depends on the size and location of the hernia as well as any other complications such as adhesions caused by scar tissue. In addition, the type of hernia (first hernia or recurrent hernia) and the patient's age are also important factors when the doctor is deciding which type of abdominal wall hernia surgery to choose.
Operations for abdominal wall hernias are relatively rarely completed without additional mesh. This form of abdominal hernia surgery is mainly used for children and adolescents and for very small hernias.
The Shouldice method is commonly used for inguinal hernias, for example. The posterior wall of the groin is reinforced with the body's own tissue and reconstructed in this way. However, this type of abdominal wall hernia surgery is only possible if the tissue is sufficiently firm.
Mayo's fascial duplication is used at any age for very small hernias. Put simply, during this operation, the surgeon stitches together overlapping edges of abdominal wall layers in the area of the defect to make the tissue more stable again.
In the case of large hernias in the abdominal wall, it can happen that the straight abdominal muscles are displaced to the side. Ramirez abdominoplasty can be the solution here. In this abdominal hernia operation, simply put, bundles of muscle fibers are detached from each other and repositioned so that they close the gap in the abdominal wall. It is an abdominal wall hernia surgery procedure that can be performed with an open incision or minimally invasively.
Mesh is used during abdominal hernia surgery to provide additional stability and reduce recurrence rates.
The most common procedure for inguinal hernias is open abdominal wall hernia surgery according to Lichtenstein. In this procedure, the gap is closed onlay with a plastic mesh, sometimes combined with a suture.
Another surgical option is called plug and patch. During this inguinal hernia operation, the surgeon uses the sublay technique to sew a kind of umbrella into the hernia gap and then a mesh onlay into the inguinal canal.
Doctors also use mesh in abdominal wall hernia operations for larger umbilical or incisional hernias in order to stabilize the abdominal wall, which is under a lot of tension.
An alternative abdominal hernia operation for large incisional hernias is the sublay technique. The scar and hernia sac are cut out and the resulting gap is closed with a mesh that is placed under the straight abdominal wall muscles on both sides.
It is also possible to perform a minimally invasive (laparoscopic) abdominal wall hernia operation, i.e. using only small incisions. A small camera, a light and instruments are inserted into the patient's abdomen through these incisions. Such an operation is performed under general anesthesia. The methods are called TAPP (transabdominal preperitoneal mesh implantation) and TEP (total extraperitoneal hernioplasty).
During these abdominal hernia operations, the doctor closes the hernia gap under the peritoneum with a synthetic mesh. The main difference between the two procedures is that TAPP involves operating through the abdominal cavity and TEP involves access between the peritoneum and the abdominal wall.
The IPOM method, on the other hand, is used for incisional or umbilical hernias. During this abdominal hernia operation, the doctor inserts the mesh laterally and places it over the defective area from the inside.
After an abdominal wall hernia operation, patients must above all take care to rest. Although it is possible to stand and walk on the first day, it is better to lie down at first after abdominal wall hernia surgery. The load can then be gradually increased. Just two weeks after abdominal hernia surgery, all normal everyday activities should be possible again, such as driving, cycling and walking.
Depending on the type of operation - open or minimally invasive - even light office activities are possible again after just a few days. Depending on the intensity of the sport, patients should only start exercising again three to four weeks after abdominal wall hernia surgery. Lifting heavy objects weighing more than ten kilos is a special case. Those affected must wait ten to twelve weeks after abdominal wall hernia surgery.
Otherwise, no special measures need to be taken after abdominal wall hernia surgery. With a protective plaster on the wound, patients can wash and shower normally. The stitches are removed by a doctor around nine to twelve days after the abdominal hernia operation.
Like any operation, abdominal wall hernia surgery can lead to unwanted complications. For example, nerve damage can occur, which is perceived by those affected as permanent pain. Also
are also possible after abdominal hernia surgery. In addition, the risk of a possible general anesthetic must be considered before deciding on abdominal wall hernia surgery.
In addition, a hernia may occur again later (recurrence), which must be closed by another abdominal wall hernia operation.
