Why we are the specialists in inguinal and abdominal wall hernias:
- We founded Europe's first centre to specialise exclusively in hernia surgery (inguinal hernia)
- We have over 20 years of experience in the surgical repair of inguinal hernias and abdominal wall hernias
- We have successfully treated more than 25,000 inguinal hernias and abdominal wall hernias
Inguinal and abdominal wall hernia surgery is regarded as "routine" surgery. With over 250,000 such procedures a year in Germany alone, this is the country's most commonly performed operation.
Conventional suturing methods were the standard treatment for all hernias up until the end of the last century. The development and introduction of alloplastic mesh materials has markedly extended the range of surgical procedures available. Today, these synthetic meshes are used in great numbers worldwide, and there are more than 100 different surgical techniques for repairing inguinal hernias.
What are "hernias" - and how are they treated surgically?
Hernias are a rupture in the soft tissues of the abdominal wall. These can be inguinal hernias and femoral hernias, or also abdominal wall hernias. The latter group includes umbilical hernias, epigastric hernias and the very common incisional hernias, which develop following previous, usually major surgical procedures involving the abdomen. These conditions should not be confused with "Gilmore's groin" or "sports hernia".
If possible, we carry out inguinal hernia operations under local anaesthetic, although if the patient prefers, we can also perform them with sedation (analgesia + sedation). This avoids any additional risks of general anaesthetic.
The surgical techniques we use are primarily "anterior" in nature, i.e. we create an access route from the front with an incision directly over the hernia. We make the decision regarding the need to use a mesh during the operation itself, since not all hernias require mesh reinforcement. All hernias are assessed during the operation according to the EHS classification system. This classification, carried out in the operating theatre, as well as individual risk factors, are factored into the decision regarding the suitability of a mesh. Known risk factors include smoking, a familial history of hernias and being overweight (obesity with a BMI of > 30). With the right constellation of factors, mesh repair of the inguinal hernia can be performed under local anaesthetic. This patient-orientated approach to individual decision-making is known as "tailored" or "customised" hernia surgery.
Inguinal hernia care (operation)
To carry out this type of inguinal hernia surgery, an understanding and routine performance of the various different surgical techniques is required. As a result, we use open suturing procedures in hernia surgery primarily for small hernial defects with good, suturable tissue (fascia) (Shouldice technique or Muschaweck's minimal inguinal hernia repair).
Larger, usually medial hernias (direct inguinal hernias), in which the posterior wall is unavailable and there is insufficient material for suturing, are repaired with mesh reinforcement using Lichtenstein's technique. In rare cases, the TIPP method may also be used (Trans-Inguinal Pre-peritoneal Plasty).
Among the minimally invasive techniques available, we offer TAPP (= Trans-Abdominal Pre-peritoneal Plasty). With this method, a laparoscopy and other skin incisions are carried out to operate on the groin from within. This method is only carried out under general anaesthetic and always requires the use of large synthetic meshes. We reserve this procedure for specific indications.
In cases of hernias affecting the anterior abdominal wall, such as umbilical and epigastric hernias, the choice of operating technique is also made based on the findings at the site and the relevant risk factors (rectus diastasis, obesity, defect size > 2 cm). If mesh reinforcement is required, then particular care will be taken during the procedure to ensure that the mesh is positioned extra-peritoneally, i.e. outside of the abdominal cavity. With the PUMP technique (Pre-peritoneal Umbilical Mesh Plasty), a flat mesh is inserted into the layer between the peritoneum and the fascia of the abdominal wall. This avoids direct contact between the abdominal organs and the synthetic mesh. These procedures are also carried out under local anaesthetic, depending on the size of the hernia.
With incisional hernias, mesh reinforcement of the abdominal wall is almost always the best approach, since in over 60% of cases that are treated using sutures only, the hernias recur (recurrent incisional hernias). Here too, an understanding and routine performance of the variety of surgical techniques is required to accommodate the anatomical challenges associated with this procedure. Our objective is to achieve extra-peritoneal mesh reinforcement of the weakened abdominal wall and restore the anatomy and physical function (retromuscular mesh augmentation / sublay technique).
A persistent problem experienced in hernia surgery is the recurrence of hernias (recurrent hernia). Recurrence rates of over 20% are quoted in hernia registers and in specialist medical literature. The choice of surgical procedure is determined by previous hernia repairs, whether they were open or minimally invasive, and whether or not synthetic mesh reinforcement was used.
Chronic groin pain can develop following an inguinal hernia repair. If the cause is not found to be a recurrence of the hernia, it is often injuries or scarred adhesions of sensitive nerves in the groin region, such as ilio-inguinal nerve entrapment syndrome, that are the culprit.