In endoscopic, minimally invasive procedures, we use camera technology to place a mesh over the hernia gap. Here we distinguish between the so-called TAPP and the TEPP procedure. Both are performed under general anaesthesia.
TAPP (Transabdominal Preperitoneal Hernioplasty):
In this tissue-conserving technique, we close the hernia gap (hernia) from the inside of the abdomen using mesh.
TEPP (Total Extraperitoneal Hernioplasty):
In this procedure, which is also tissue-conserving, the abdominal cavity is not opened, but the mesh is placed in the tissue layers of the abdominal wall.
The open surgical procedures can be carried out with a net (Lichtenstein operation) or without a net (Shouldice operation). We usually perform both under general anaesthesia.
In Shouldice surgery, the inguinal hernia is exposed through an incision in the area of the inguinal ligament and closed with a multi-layered suture. A mesh insertion is not necessary here.
In the Lichtenstein operation, the inguinal hernia is also exposed via an incision above the inguinal ligament and closed with mesh reinforcement.
After surgical interventions, the soft tissue in the area of the scars can move apart. A tissue gap, the so-called scar hernia, develops. Without surgery, this gap will become larger and larger over time. To prevent part of the intestine from becoming trapped in the hernia, the hernia should be closed surgically. The surgical procedure of choice depends on many factors, especially the degree of adhesions to be expected and the size of the hernia. The diagnosis can usually be made by a physical examination in combination with an ultrasound scan. Sometimes the addition of a CT scan is useful. Smaller scar hernias can be treated on an outpatient basis. For larger hernias, a hospital stay of one to two days is usually advisable. We perform the operation under general anaesthesia.
In rare cases, pre-operative Botox treatment of the lateral abdominal muscles can facilitate closure of the incisional hernia.
A hernia can also develop in the area of the navel in the course of life. As with all abdominal wall hernias, the intestine can become trapped in the hernia gap, so that an operation is usually necessary here too. The operation is also performed under a short general anaesthetic. Smaller umbilical hernias can be closed with a firm suture. For larger hernia gaps, the insertion of a mesh to reinforce the tissue is advisable.
In most cases, the diagnosis of an umbilical hernia can be made by physical examination, if necessary supplemented by an ultrasound. In rare cases, a CT scan is necessary.
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