Other hernias
In addition to the well-known hernias in the abdominal region, such as umbilical and inguinal hernias, there are also lesser-known ones. These include femoral hernia, incisional hernia, mirror hernia and parastomal hernia, which will be described in more detail.
Femoral hernia
Femoral hernia occurs preferentially in women, but can also be presented regularly as an incidental finding during minimally invasive inguinal hernia surgery.
Due to an increased risk of entrapment (incarceration), a femoral hernia should always be operated on within 3 months, otherwise emergency surgery may result.
In contrast to the inguinal hernia, the femoral hernia is located somewhat deeper, i.e. below the inguinal ligament, and is often difficult to diagnose. It is important to perform an ultrasound in the standing and supine position to confirm the suspected diagnosis.
The operation should always be performed minimally invasive as TEP or TAPP with mesh insertion.
Incisional hernia
The scar hernia always develops after a previous operation. This can also be many years ago, as in the case of appendectomy.
Frequently, these are larger abdominal incisions in the midline of intestinal operations. This line is a general weak point of the abdominal wall, so that abdominal wall hernias can develop preferentially here.
However, keyhole operations such as removal of the blínd intestine or gall bladder can also lead to an incisional hernia. These should be treated surgically if possible, as the hernia gap becomes larger over the years and parts of the intestine can become trapped.
The surgical procedure is very dependent on the location and size of the hernia. However, a mesh should always be inserted, since recurrence (recurrence) of the hernia is very common with suture-only procedures.
In the case of incisional hernia, there are most procedures. The size of the hernia, the number of previous operations and the location of the hernia in the abdominal region are particularly important for the choice of therapy. Due to the size and complexity of the hernia, most of the procedures are performed as inpatient surgeries. The stay is between 2 and 7 days.
The keyhole technique should only be used for hernias up to a size of 8 cm, because otherwise the stability is too low, more hernias occur again (recurrences) and the abdominal wall can bulge at the site. This would correspond to a pseudorecurrence and be visually disturbing. Since the hernia gap often cannot be completely closed, fluid accumulations of wound water (seromas) are also more likely to form here.
In principle with mesh
Even minor incisional hernias should always be reinforced with a mesh, as the risk of recurrence is otherwise significantly increased.
The implanted meshes do not dissolve and must overlap the hernia gap by at least 5 cm in each direction, i.e. they are significantly larger than the hernia gap.
Which position: onlay, sublay, IPOM?
The position of the mesh is particularly important for the stability of the reconstructed abdominal wall. Which method is used cannot always be precisely determined from the outset and is decided during the operation. Therefore, the patient must be informed about all options in advance in a discussion.
In the ONLAY procedure, the mesh lies on the firm abdominal wall (fascia). Only the subcutaneous fatty tissue and the protective epidermis remain on top. The procedure is technically not too complex and the abdominal cavity is not opened. The disadvantage is the increased risk of recurrence, which is why it is performed only in exceptional cases.
The SUBLAY procedure is better. This is currently recommended as the standard operation. The mesh is placed between the muscle and the lower connective tissue layer of the straight abdominal muscle (posterior fascial sheet) after a detailed dissection. As a result, it lies very stable and grows in well. Disadvantages are the increased risk of post-operative bleeding and greater tissue damage.
Recently, the hybrid technique MILOS (minimally invasive less open surgery) has become possible, whereby large stable meshes can be inserted through very small incisions - for us this is a top procedure for the future.
IPOM (Intraperitoneal Onlay Mesh) can be performed both minimally invasively and openly via a skin incision. The mesh is usually placed in the abdominal cavity and tightened with staples that dissolve after 3-6 months. Alternatively, it can be placed on the peritoneum, in which case there are fewer adhesions with the structures inside the abdomen. The disadvantage besides adhesions is increased pain during the first 5 days.
Lateral hernia (Spieghel hernia)
These lateral hernias are very rare and are often not properly diagnosed. An ultrasound examination is conclusive in this case.
These hernias occur laterally next to the rectus sheath (this is the so-called "six pack" muscle) and occurs in a semi-modular strip of connective tissue (linea semilunaris).
These hernias are named after the Flemish physician and anatomist Adriaan van den Spieghel.
Since these hernias have a close connection to the small intestine, the risk of entrapment is significantly increased, which is why surgical treatment should always be attempted. Here, the keyhole technique is of great advantage, in which the mesh can be placed between the peritoneum and the abdominal wall, without contact with the intestine.
Stoma hernia (Parastomal hernia)
These are hernias around an artificial bowel outlet (stoma). In this case, small and large bowel outlets are combined. In the case of stomas that are not temporary, i.e. remain forever, these hernias must be treated surgically.
Hernias in temporary bowel outlets such as after severe inflammation of the sigmoid colon or as protection after bowel surgery of the rectum are also removed 3-6 months after the initial surgery during the planned re-transfer. However, due to the risk of infection with intestinal bacteria, a net should not be inserted.
The operation should preferably be performed using the keyhole technique. However, due to pronounced adhesions, this is often technically not possible.
Important: We offer this operation on request through a network of experienced hernia specialists.
Diaphragmatic hernia (Hiatal hernia)
Hiatal hernias, also called diaphragmatic hernias, represent a pathological dilatation of the diaphragm where the esophagus enters the abdominal cavity. Due to an insufficient closure of the esophageal muscle, this can lead to ascending of gastric juice (reflux) with the discomfort of heartburn.
In the case of larger defects, parts or even the entire stomach can slip into the thorax (upside-down stomach). This can lead to swallowing difficulties or even bleeding.
The operation can only be performed on an inpatient basis and patients stay in the hospital for 2-5 days.
Therapy
After extensive diagnostics and confirmation of reflux, surgery can provide relief. Here, the standard method is surgery via laparoscopy.
In the first step, the hiatal hernia is securely closed with several sutures (hiatoplasty). In the case of larger defects or recurrences, the implantation of a mesh is necessary. It is essential that this mesh can be dissolved, otherwise it can cause considerable damage to the esophagus.
The second step is the formation of a cuff from the upper part of the stomach (fundoplicatio), which can be either a complete cuff (360° according to Nissen) or a partial cuff (270° according to Toupet).
Important: We offer this operation on request through a network of experienced hernia specialists.
You are welcome to book an appointment online in our appointment calendar DOCTOLIB under the specialty "Visceral surgeon and proctologist" with our doctors. We are looking forward to it.