Hernias are acquired or congenital tissue hernias in the abdominal wall or diaphragm. The "hernia" refers to a break through the abdominal wall or the diaphragm.
A hernia is caused by a weak point in the respective tissue. With a corresponding predisposition and strain, a gap can develop here, the so-called hernial orifice. Depending on the type of hernia, parts of the peritoneum, intestine or stomach can pass through.
In the case of abdominal wall hernias, the hernia sac that has passed through can be felt from the outside as a protrusion and may be visible. This is therefore an external hernia.
Internal hernias form due to a weak point in the diaphragm. In this case, parts of the stomach are pushed into the chest.
Hernias do not always lead to pain and symptoms. In some patients with an external hernia, only the bulging hernia sac can be seen under the skin.
Initially, this outwardly displaced hernia can be pushed back into place. Although this so-called repositioning initially relieves pain, it does not heal the hernia. On the contrary, the hernia can enlarge further over time, which in turn makes surgery more likely.
Internal diaphragmatic hernias (hiatal hernias), on the other hand, usually cause pain after eating or when lying down.
Hernias cause pain when intestinal loops protrude outwards through the hernia gap and become trapped. This can interrupt the blood supply to the intestinal parts. This situation of an incarcerated hernia is always a medical emergency.
Surgery must be performed quickly to restore the blood supply. This is the only way to prevent the death of the intestinal tissue and prevent peritonitis.
Types of hernia that require surgical treatment are
A hernia does not heal on its own. Conservative measures such as pushing back and hernia bands are not enough. You should therefore discuss the possibility of surgical treatment of the hernia with a hernia specialist at an early stage.
In the case of an abdominal wall hernia, parts of the organ protrude from the abdominal cavity through the abdominal wall to the outside. Minimally invasive hernia surgery can help here © blueringmedia | AdobeStock
Hernia surgery is a specialization of visceral surgery. Visceral surgery deals with operations on the internal organs.
The basic procedure for hernia surgery is as follows: The hernia surgeon relocates the tissue parts located in the hernia sac back into the abdominal cavity. He then closes the hernial opening either with a suture or with an artificial mesh to reinforce the weak point in the tissue. The mesh helps to prevent a new rupture.
A basic distinction is made between the following procedures
- open surgery and minimally invasive surgery as well as
- methods with or without mesh implantation.
Which method is used depends on
- the expertise of the surgeon
- the resources available,
- the size and type of hernia and
- patient's own factors, such as age and state of health.
and health.
Minimally invasive techniques are also known as keyhole surgery. These procedures do not require long tissue incisions. In open surgery, the surgeon exposes the surgical area by cutting through the overlying tissue. Minimally invasive procedures, on the other hand, are closed, i.e. performed directly in the body without direct vision.
The surgeon makes several small incisions in the skin, each one centimeter long. The surgeon inserts the required instruments, a camera and a light source through these openings. The image from the camera is transmitted to a monitor so that the doctor can see the surgical area enlarged.
The procedure is performed under general anesthesia.
In contrast to open hernia surgery, minimally invasive hernia surgery does not result in large scars. At the same time, the surgical wounds heal faster because they are much smaller and the surgeon does not have to cut any muscles.
Proven minimally invasive procedures, for example for inguinal hernias, are
- TAPP (laparoscopic transabdominal patchplasty): The operation is performed via the abdominal cavity.
- TEP (endoscopic preperitoneal patchplasty): The operation is performed in the intermediate layer between the peritoneum and the muscle wall, the abdominal cavity is not opened.
Immediately after the operation, pain is relieved with medication and the surgical region is cooled with cooling pads.
As a rule, hernia patients are mobilized in the clinic just a few hours after the minimally invasive procedure. This means that they are encouraged to stand up and walk a few steps. This prevents thrombosis and improves circulation.
Patients are usually discharged from hospital after a few days. After three to five days, daily activities are recommended.
Physical exertion should be avoided at the beginning, as should straining during bowel movements. "Stay pain-free" is not just a well-intentioned wish from your doctor, but also the measure of your personal activity level after the operation. As long as you don't feel any pain, it's okay to feel your way carefully towards activities.
Minimally invasive hernia surgery has the advantage that
- patients are usually mobile again more quickly and
- wound healing is completed more quickly.
After two to four weeks, minimally invasive hernia patients are usually able to work again. The attending physician will provide detailed advice on the individual course after hernia surgery.
The general risks of minimally invasive hernia surgery include
The clinic and nursing staff prevent these risks with the appropriate care and precautionary measures.
- Swelling,
- bruising and
- accumulation of tissue fluid
in the operated area can also occur during minimally invasive hernia surgery. However, these symptoms usually disappear on their own after a short time.
