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Safe hernia surgery using mesh

©draganagordic / Fotolia

[22.10.2018]

In the beginning, Peter H. feels only slight pain and a tugging in his stomach. A few days later he notices a swelling in the groin when standing, which disappears when lying down. The family doctor immediately diagnoses a hernia and refers him to the Medical Center - University of Freiburg. "Generally speaking, a hernia is viscera, such as the intestines, protruding due to a defect in the abdominal wall," says the surgeon Dr. Philipp Holzner, specialist in the Department of General and Visceral Surgery of the Medical Center - University of Freiburg.

A hernia protrudes through the external inguinal (groin) ring, and can then be seen and felt. In rare cases, the viscera are so pinched that they cannot push back into place on their own. This is associated with increasing pain and sometimes vomiting. "An incarceration like this is a medical emergency requiring surgical intervention. Those affected should present themselves immediately in a surgical outpatient clinic," says Dr. Holzner.

Men are affected ten times more often

Hernias can appear in naturally-occurring weak areas of the abdominal wall, or in the scar area after abdominal surgery. But they appear most often in the inguinal region. Hernia surgery is carried out around 275,000 times a year in Germany. Men have hernias about ten times more often than women. Aside from inguinal hernias, umbilical and incisional (scarring) hernias often occur. In addition, there are also rare hernias of the abdominal wall.

How does a hernia develop?

"A hernia is usually caused by a weakness in the abdominal wall, especially in congenitally weak spots or scar areas after abdominal surgery," says Dr. Holzner. "A weak spot in men is the area of the inner inguinal ring through which the spermatic cord runs to the testicles. Sometimes hernias are already present at birth, or else they arise in the course of life. Usually, several factors come together for a hernia to develop. A crucial factor is the stability of the connective tissue, which varies individually."

Can lifting cause a hernia?

Lifting heavy weights, or high physical stress, only leads to a hernia if the connective tissue can no longer withstand the load. This means that the same stress over a number of years on a person with weaker connective tissue can lead to a hernia, but not in a second person with stronger connective tissue. "Consequently, the idea of lifting causing a hernia is partially false, since stress is just one factor in hernia development," explains the surgeon.

What are the possible treatments?

The only treatment for a hernia is surgery. The medical guidelines recommend, as the best option, inguinal hernia surgery by means of mesh reinforcement. Instead of sewing the break directly, a plastic mesh is placed in the hole, which overlaps with the surrounding tissue. Thus the body is stimulated to form a connective tissue layer in the mesh area. "If the mesh is placed correctly, it can significantly reduce hernia recurrence. In addition, very large ruptures can be treated, which otherwise could not have been closed by the body's own tissue," says Dr. Holzner.

In most cases, the surgeon advises against using a hernia truss or abdominal belt. "A hernia truss can prevent the emergence of a rupture and therefore, if applicable depending on the stress, an increase in size, but it weakens the abdominal muscles and thus contributes indirectly to the progression of the disease. However a belt or truss can be used in the short term, meaning before an operation," explains Dr. Holzner.

Comprehensive help for complex cases

Things become more complicated if the hernia recurs after surgery, and when hernias occur in several places. "We have, as a center for maximum care and as part of the Medical Center, in addition to the routine care of hernias, special experience in the treatment of multiple recurrent inguinal hernias as well as parastomal and incisional hernias," says Professor Dr. Stefan Fichtner-Feigl, Medical Director of the Department of General and Visceral Surgery of the Medical Center - University of Freiburg. For inguinal hernias, minimally-invasive keyhole surgery is often possible.

When does outpatient surgery make sense?

Planned hernia surgeries may be performed under general, spinal or local anesthesia. "We have had good experience in dealing with uncomplicated hernias on an outpatient basis," says the Freiburg visceral surgeon. This gentle surgical method often allows the patient to return home the same day.

This is possible especially for patients without serious concomitant diseases of the heart and lungs. But patients with comorbidities are also often treated at the Medical Center - University of Freiburg. "These patients must be hospitalized in order to guarantee maximum safety," says Professor Fichtner-Feigl.

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