Minimally Invasive Hernia Surgery: Gentle Surgical Treatment of Abdominal Wall Hernias in Modern Surgery (Minimally Invasive Keyhole Surgery)

Hernias are acquired or congenital tears in the abdominal wall or diaphragm. The term “hernia” refers to a rupture through the abdominal wall or diaphragm.

A hernia develops due to a weak spot in the affected tissue. With a genetic predisposition and increased pressure, a gap—known as the hernial orifice—can form here. Depending on the type of hernia, portions of the peritoneum, the intestine, or the stomach may protrude through this opening.

In abdominal wall hernias, the hernial sac containing the protruding organs can be felt as a bulge from the outside and may be visible. This is therefore an external hernia.

Internal hernias form due to a weak spot in the diaphragm. In these cases, parts of the stomach are pushed into the chest cavity.

Hernias do not always cause pain or symptoms. In some patients with an external hernia, only the bulging hernia sac is visible under the skin.

Initially, this hernia that has protruded outward can be pushed back into place. Although this so-called reduction provides temporary relief from pain, it does not cure the hernia. On the contrary, over time the hernia may continue to enlarge, 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 loops of intestine pass through the hernia opening and become trapped. This can interrupt the blood supply to the affected sections of the intestine. This condition—an incarcerated hernia—is always a medical emergency.

Surgery must be performed quickly to restore blood flow. This is the only way to prevent the intestinal tissue from dying and to avoid peritonitis.

Types of hernias that require surgical treatment include:

• Inguinal hernia
• Umbilical hernia
• Abdominal wall hernia
• Femoral hernia
• Incisional hernia
• Parastomal hernia
• Diaphragmatic hernia

A hernia does not heal on its own. Conservative measures such as pushing the hernia back into place and using hernia trusses are not sufficient. Therefore, you should discuss the possibility of surgical treatment for the hernia with a hernia specialist at an early stage.

Hernia surgery is a subspecialty of visceral surgery. Visceral surgery deals with operations on the internal organs.

The basic procedure for hernia surgery is as follows: The hernia surgeon returns the tissue segments located in the hernial sac back into the abdominal cavity. The surgeon then closes the hernia defect either with sutures or by inserting a synthetic mesh designed to reinforce the weakened area of tissue. The mesh helps prevent the hernia from recurring.

In terms of procedures, a basic distinction is made between

• open surgery and minimally invasive surgery, as well as
• methods with or without mesh implantation.

Which method is used depends on

• the surgeon’s expertise,
• the available resources,
• the size and type of hernia, and
• on patient-specific factors, such as the patient’s age and overall health

.

Minimally invasive techniques are also known as keyhole surgery. These procedures do not require long incisions in the tissue. In open surgery, the surgeon exposes the surgical site by cutting through the overlying tissue. Minimally invasive procedures, on the other hand, are performed “closed,” meaning without a direct view inside the body.

To do this, the surgeon makes several small skin incisions, each about one centimeter long. Through these openings, the surgeon inserts the necessary instruments, as well as a camera and a light source. The camera’s image is transmitted to a monitor, allowing the surgeon to view the surgical site magnified.

The procedure is performed under general anesthesia.

Unlike 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 through any muscles.

Proven minimally invasive procedures, for example for inguinal hernias, include:

• TAPP (laparoscopic transabdominal patch repair): The surgery is performed through the abdominal cavity.
• TEP (endoscopic preperitoneal patch repair): The surgery is performed in the space between the peritoneum and the abdominal wall; the abdominal cavity is not opened.

Immediately following the surgery, pain is relieved with medication, and the surgical site is cooled with cold packs.

Typically, hernia patients are encouraged to get up and move around just a few hours after the minimally invasive procedure. They are therefore encouraged to get up and take a few steps. This helps prevent blood clots and promotes circulation.

Patients are usually discharged from the hospital after a few days. Resuming daily activities is recommended after three to five days.

Physical exertion should be avoided at first, as should straining during bowel movements. “Stay pain-free” is not only a well-intentioned wish from your doctor, but also the measure of your personal activity level after surgery. As long as you don’t feel any pain, the level of exertion is fine; approach activities cautiously.

Minimally invasive hernia surgery has the advantage that

• patients are generally back on their feet more quickly and
• wound healing is completed more quickly.

After two to four weeks, patients who have undergone minimally invasive hernia surgery are usually able to return to work. Your treating physician will provide detailed advice on your individual recovery after hernia surgery.

General risks associated with minimally invasive hernia surgery include

• bleeding,
• wound healing complications,
• infections, and
• thrombosis.

The hospital and nursing staff work to prevent these risks through appropriate care and preventive measures.

• Swelling,
• bruising, and
• accumulations of interstitial fluid

in the operated area can also occur during minimally invasive hernia surgery. However, these symptoms usually resolve on their own after a short time.