By DR. MED. JÖRG ZEHETNER, Professor (USC), Specialist in Surgery, esp. Visceral surgery
EVERY YEAR, AROUND 600 PEOPLE IN SWITZERLAND ARE DIAGNOSED WITH OESOPHAGEAL CANCER. MEN ARE PARTICULARLY AFFECTED, ACCOUNTING FOR THREE QUARTERS OF ALL CASES, AND ARE SIGNIFICANTLY MORE LIKELY TO FALL ILL THAN WOMEN. WE EXPLAIN TO YOU WHAT OESOPHAGECTOMY IS ALL ABOUT. REFLUX DISEASE IS THE BIGGEST RISK FACTOR FOR OESOPHAGEAL CANCER.
Fatty liver, non-alcoholic fatty liver, liver cirrhosis, liver cancer, hepatitis as infection of the liver and many other liver diseases are common. It is estimated that the proportion of people diagnosed with fatty liver in developed European countries is around 20 percent, with a certain number of unreported cases, as mild and symptom-free courses of the disease are hardly recognised.
A distinction is made between three degrees of severity of fatty liver, initially regardless of whether it is alcoholic or non-alcoholic.
Mild fatty liver – In this case, less than one third of the liver cells are affected by excessive fatty degeneration.
Moderate fatty liver – At this stage, a proportion of less than two-thirds but more than one-third of the liver is already excessively fatty.
Severe fatty liver – In this degree of severity of fatty liver disease, more than two thirds of the liver cells are already excessively fatty.
Fatty liver cells result from the storage of fat in the liver cells, which ultimately significantly impairs the function of the liver as an important organ. Consequential diseases or concomitant diseases such as diabetes are not excluded, but are often a complication caused by the disturbed fat metabolism in the liver.
The severity of fatty liver disease can be determined by examining a tissue sample from the liver. In the process, a tiny part is taken from the organ and subjected to a fine-tissue examination. Examinations of the cholesterol level or the blood lipid values also provide valuable information.
A healthy liver promotes a healthy life
Alcoholic or non-alcoholic fatty liver?
Many liver diseases are diagnosed in close association with the excessive consumption of alcohol. Anyone who is more familiar with the chemical composition of alcohol knows that it is a modified form of sugar, i.e. carbohydrates. An excess of carbohydrates is deposited in the body as fat and finds its place especially in the liver. Accordingly, many chronic alcoholics are affected by liver diseases up to severe forms.
But also, and this should be a cause for concern, a large proportion of non-alcohol-related liver diseases are spreading in society. Such manifestations of fatty liver are mainly due to wrong eating and living habits, which are mainly represented by excessively fatty and sugary diets. What the body cannot process, it not only deposits in the fat depots of the lower skin layers, but also in the liver, which then leads to fatty liver.
What to do for fatty liver?
Once an alcoholic fatty liver has been diagnosed, the only thing that helps is a strict and consistent renunciation of alcohol. Only the radical renunciation of alcoholic beverages can still offer a spark of hope that the consequences of alcohol abuse on liver health can still be mitigated.
In the case of non-alcoholic fatty liver, the chances of recovery are relatively good, depending on the severity. What is important is a consistent change in diet combined with more active exercise. This change can be supported by so-called liver fasting, which we will look at in more detail in a separate section. In principle, it is always important to prevent scarring of the liver tissue, which is referred to in medical terminology as cirrhosis of the liver. Cirrhosis of the liver is beyond repair and represents a dangerous structural change in the liver tissue that cannot be reversed.
Once a fatty liver has been diagnosed, depending on its severity, it is important to make actual changes to halt and, if possible, reverse the process of fatty liver. Half-hearted measures help relatively little. Also because a relapse into old lifestyle and dietary habits will always lead to progressive damage to the liver.
Treatment of fatty liver with medication or surgery is not possible. In the case of a fatty liver, the only thing that can help is to tackle the causes, which are to be found either in excessive alcohol consumption, in the wrong diet that is too rich in fat, or in a combination of both. Some rare forms of fatty liver are due to medication or other episodes, but are negligible in this paper.
Who is affected?
If you follow the statistics, about 20 percent of our society is affected by non-alcoholic fatty liver. The age of patients ranges from 40 to 60 years, with women being affected by fatty liver slightly more often than men.
It is noteworthy that many patients with fatty liver are significantly overweight (obesity) or already suffer from diabetes in various stages. Elevated blood lipid levels are as common as the occurrence of metabolic syndrome.
Even if the actual causes of a fatty liver have not yet been fully researched, it can be assumed that there is basically a disproportion between energy intake and energy consumption. This means that in the long term or permanently, significantly more calories are supplied to the body than are actually consumed.
Even though fatty liver is often associated with alcohol abuse in the general perception, the proportion of non-alcoholic fatty liver is much higher than that of alcoholic fatty liver disease.
Liver fasting according to Dr. Worm – a good therapy for non-alcoholic fatty liver
A liver fast according to Dr. Worm is an effective means of individually and successfully combating fatty liver. Even without a specific medical diagnosis, but especially after a diagnosis of non-alcoholic fatty liver, liver fasting according to Dr. Worm offers excellent possibilities for a targeted and healthy defatting of the liver without overtaxing the organism. However, it must also be said that any form of dietary nutrition, including liver fasting according to Dr. Worm, does not work without renunciation and one’s own will.
This is how liver fasting according to Dr. Worm works
Dr. Nicolai Worm is one of the best-known nutritionists of our time. Based on years of experience in nutritional counselling and supported by current scientific findings, Dr. Worm has developed liver fasting with Hepafast together with the nutritional physician Dr. Hardy Walle, MD. Such a diet is by no means new territory, but is based on the experience of many decades of research, science and practice.
The special thing about the Hepafast cure is that it specifically addresses the requirements and physical circumstances related to a fatty liver. This means that with the targeted Hepafast liver fasting cure, which is limited to a few weeks, the fat levels of the liver can be specifically influenced.
If the liver fasting cure according to Dr. Worm is carried out correctly, the fat metabolism is naturally influenced, which in the majority of cases also leads to a general weight loss. Both the blood fat values and the liver fat values recover noticeably, the success of liver fasting can be observed and experienced by the person doing it. Unlike many other diets, the feared yo-yo effect is not to be expected, as the Dr. Worm liver fast is not a starvation diet, but is accompanied by valuable ingredients in an easy-to-prepare drink.
Of course, liver fasting with Hepafast makes no sense if the diet and lifestyle in general are not changed at the same time. However, as Hepafast works naturally and is filling, continued excessive food intake is neither felt nor factually necessary. The affected persons therefore eat more sensibly and healthily, do not have to starve themselves and simply supplement their diet with Hepafast. This leads to a significant decrease in fat levels and thus to improved health, which is also noticeable in performance after just a few weeks.
When is liver fasting according to Dr. Worm useful?
In principle, liver fasting according to Dr. Worm always makes sense at the latest when symptoms of a fatty liver are noticed. However, a fatty liver in the first degree of severity is not associated with any individual complaints and is therefore usually not even noticed.
It is good that liver fasting according to Dr. Worm can also be carried out preventively, without deficiency symptoms or too abrupt changes in lifestyle. Step by step, users can familiarise themselves with the mode of action of liver fasting and are then guided themselves to make their lifestyle and eating habits more sensible.
Liver fasting according to Dr. Worm is particularly recommended after the cold season. In winter, most people exercise a little less anyway, rich and fatty food is often part of everyday life in winter, and around Christmas and spring is the best time to activate the body again. Especially since Lent is in full swing then anyway. In addition, liver fasting according to Dr. Worm with Hepafast can be used practically any time of the year.
This is how liver fasting with Hepafast works
In many years of nutritional research, Dr. Nicolai Worm and Dr. Hardy Walle, MD, have put together a formula that has a measurably positive effect on liver fat values. The special composition and easy handling of the Hepafast liver cure helps to boost fat burning and successfully reduce the storage of fat in the liver cells. Finally, the ingredients of the Hepafast cure also have an effect on the fats already stored in the liver and can effectively break them down.
A prerequisite for a successful liver fasting cure with Hepafast remains a sensible change in lifestyle and dietary habits. Hepafast is not a miracle cure, but a nutritionally compounded support for defatting the liver and for overall better eating habits. Accordingly, Hepafast is not a food supplement, but replaces part of the diet with liver-active components when used as intended.
In concrete terms, this may mean that lunch or another meal is replaced by a Hepafast Shake prepared as intended. There is no need to fear a feeling of hunger, as Hepafast is satiating and at the same time can break down fat molecules in the body. The fear of an unbalanced diet or malnutrition is also not justified, as other meals can also be taken when using Hepafast, which then contain the substances required by the body. A Bodymed Hepafast liver cure is not a diet that focuses primarily on renunciation, but rather a targeted influence on fat burning in the body. Ideally, Hepafast not only helps burn fat cells, but can also promote weight loss. In addition, the effects of liver fasting with Hepafast boost the body’s own forces and energies, which can generally lead to an improved sense of well-being and higher performance. It is important to know that in liver fasting according to Dr. Worm, the focus is not on radical or large-scale weight loss, but on naturally flawless liver function.
Experience reports with Bodymed Hepafast Liver Fasting according to Dr. Worm
Years after the first introduction of liver fasting according to Dr. Worm, there are thousands of enthusiastic and successful users who have not only been able to reduce the degree of liver fatty degeneration, but also to take preventive action against possible liver fatty degeneration. And that with relatively little effort and sacrifice, but a liver-healthy dietary pattern that is excellently supported by Hepafast.
In the Swiss1Chirurgie clinics, we also support and recommend liver fasting out of the knowledge that overweight people in particular often suffer from non-alcoholic fatty liver, even if they do not always feel it immediately. Healthy liver function plays a significant role in well-being. Conversely, a balanced, varied and healthy diet always promotes liver health. This can be supported very well with Hepafast liver fasting according to Dr. Worm.
Here are some feedbacks from people who regularly do the liver fasting according to Dr. Worm.
“As a player and as a coach, I have been paying a lot of attention to my diet for years. I tried out many different ideas and projects to be able to talk to my players about performance optimisation.
3 years ago I consciously detoxified my liver for the first time on recommendation. I was curious to see what the body would do to me. 14 days of iron discipline. Protein shake, vegetables, counting calories was the routine that accompanied me every day.
The result: 5 kilos lost, vital, motivated, dreams, fit in spirit, conscious handling of nutrition and real enjoyment. Not once did I feel hungry. I was allowed to get to know many interesting, creative menus. In short, “it was worth it.”
I can highly recommend liver fasting with a clear conscience. Bottom line: do something good for yourself while you wait for happiness.”
Martin Andermatt, football player and coaching legend
“Thanks to liver fasting, I experienced unique things at the beginning of each of the last years.
Whether on a snowshoe tour through the Ottmar Hitzfeld GsponArena or in the home office, whether at the CSI event in Basel or the Lauberhorn Races in Wengen, 14 days changed my consciousness with liver fasting. For 14 days, the perfect-tasting Bodymed shake was my faithful companion and made every single day a pleasure.
I was able to experience positive things: Better well-being, deeper sleep, reduced fatigue, healthy eating, weight loss. And liver fasting brings even more welcoming side effect – it saves valuable time, is easy on the wallet and helps you learn new cooking habits.
“Liver fasting means 5 star health for me.”
And who knows, with a little luck, the intense dreams will come true thanks to liver fasting … “
Fabian Furrer
“I treat myself to a liver fasting course of Hepafast once or twice a year. With a BMI of 24, I do this not to regulate my weight, but because it means wellness for my body. I feel much fresher after the cure, which is also confirmed by my blood values (cholesterol and liver values). The most important thing for me, however, is that I don’t have to go hungry at any time with the Hepafast cure! The shakes taste good and give a good feeling of satiety. The recommended meals are easy to prepare and bring a lot of variety into the diet. And last but not least: I’m on the road a lot, but I can easily take the shakes and vegetable snacks with me and prepare and enjoy them “on the go”.”
Markus Fuhrer
“I am very satisfied with the liver fasting according to Dr. Worm, Hepafast, which was prescribed to me by Dr. Jörg Zehetner, MD. My laboratory values, especially cholesterol, are now all at a good level and I have lost 15 kg in one year because my eating habits have changed after the fast. I will repeat the cure every spring to stay in shape.”
Erika Fuhrer
Now, the series of experiences with Hepafast and a liver fast according to Dr. Worm could be extended almost indefinitely. However, we are of the opinion that only one’s own trial and error with one’s own personal experiences in liver fasting is really useful and meaningful.
Accordingly, we at Swiss1Chirurgie recommend that you make your own experiences with liver fasting according to Dr. Worm. “Because there is nothing good unless you do it!”
You will receive appropriate professional and medical advice on liver fasting according to Dr. Worm with Hepafast gladly and in detail in every Swiss1Chirurgie clinic and also in the other affiliated clinics within Helvetia Holding AG.
The need for information on medical issues is growing. Especially those affected who face medical questions and problems also look for answers to their individual questions on the internet. Unfortunately, the online information from the search engine results of Google and Co. is not always accurate and in many cases not sufficiently well-founded. As a result, many people move in a grey area between self-diagnosis with not always reliable information and the need for a profound and, above all, factually correct diagnosis by the respective medical specialists.
The experts at Swiss1Chirurgie have long recognised the need for comprehensive and, above all, professional information and offer comprehensive information options on specialist medical questions in the respective service areas on the websites of Swiss1Chirurgie, the Centre for Bariatric Surgery ZFBC, the Gastroenterology Group Practice GGP Bern and the Bern Clinic PZBE.
Swiss1Chirurgie Podcasts – Listening instead of reading
The podcasts, which are offered on the initiative and under the content supervision of Dr. Jörg Zehetner, are a relatively new information service for the medical layperson but also for specialist colleagues.
This means that there is also a professional information service for those affected, who can get an initial overview of diagnoses, medical interventions, surgical techniques and aftercare as well as accompanying services.
Podcasts on the following topics are currently available:
Medical knowledge – Obesity (Complex bariatric surgery)
Medical expertise and expert advice on Radio Bern1
Swiss1Chirurgie informs patients and endocrinologists (overweight surgery possible from BMI 30 with diabetes)
Gastric balloon only a “crutch” for overweight patients
Inguinal hernias and modern 3-D net care
Abdominal wall hernias, closure with net insertion
Further podcasts are in the works and are constantly expanding the range of information for patients but also for referring doctors.
With the podcasts, Swiss1Chirurgie, as an obesity expert centre and hernia centre, has created an extended information option that makes knowledge available and at the same time provides the appropriate recommendations.
It is important to note that those affected by a surgical problem can also contact the Swiss1Chirurgie clinics in Bern, Brig and Solothurn directly at any time. In this way, well-founded diagnoses can be made for individual “suspicious cases”, which enable professional further treatment.
Those in need of information about the services offered by Swiss1Chirurgie are invited to make use of the free Swiss1Chirurgie podcast offer. Knowing what is is always better than guessing what could be.
Welcome to the new Swiss1Chirurgie podcast. In this podcast from the Hernia Centre at Swiss1Chirurgie, we look today at the topic of diaphragmatic hernias and their closure by means of a net insert, hiatoplasty or fondopexy.
The podcast was based on an idea and text by Prof. Dr. Jörg Zehetner. Jörg Zehetner is, among other things, the owner of Swiss1Chirurgie and attending physician at the Hirslanden clinic Beau-Site.
This podcast series is intended as patient information for patients and all those who are interested in the topic of hernias, especially diaphragmatic hernias and their treatment with net insertion, hiatoplasty and fundopexy.
In previous podcasts we have already dealt with inguinal hernias and abdominal wall hernias. If you have already listened to these podcasts, you already know what is meant by a hernia. These are always ruptures in the tissue, which cause internal organs to move completely or partially out of their physiologically correct position. This can be associated with more or less severe pain. Depending on the specific fracture, the blood and oxygen supply to the affected organs may be impaired or completely interrupted, which under unfavourable circumstances can lead to the death of the organ parts in the hernia sac and endanger life. Often hernias are visible on the surface of the body or can be felt quite easily by experienced surgeons and general practitioners.
It is different with a hiatal hernia, which is called a hiatal hernia or paraoesophageal hernia in medical parlance. The diaphragmatic hernia is neither visible nor palpable from the outside.
Simple anatomy of diaphragm and cardia
As with other hernias, the hiatal hernia is caused by a tissue weakness, in this case by a weakness at the junction of the oesophagus between the chest cavity and the abdominal cavity. At this transition, the diaphragm forms the boundary between the thorax and abdomen. The oesophagus runs through an anatomically normal opening in the diaphragm. This opening is called the hiatus and refers to the diaphragmatic cuff or thigh as the anatomical passage of the oesophagus through the diaphragm. The transition from the oesophagus into the stomach is called the cardia; the correct medical term here is cardia ventriculi or pars cardiaca.
The cardia is in the true sense not only the entrance to the stomach but also the muscle that prevents gastric acid from being expelled into the oesophagus or food from flowing back out of the stomach. When stomach acid is regurgitated, we speak of reflux. If the cardia is not sufficiently stable in its function as a valve, repeated episodes of reflux can occur, which can lead to oesophageal cancer due to the constant attack of stomach acid on the inner wall of the oesophagus.
Diagnosis diaphragmatic hernia
A hiatal hernia is a condition where the lower end of the oesophagus, or cardia, slips up through the opening in the diaphragm into the chest cavity. This often pulls the upper part of the stomach into the thorax.
In most cases, there are then between two and five centimetres of the stomach in the chest cavity. Since, in contrast to the abdominal cavity, there is a slight negative pressure in the chest cavity, the diaphragmatic hernia favours increased reflux episodes with the corresponding complaints and possible reflux diseases. This ultimately also leads to a further weakening of the already insufficient sphincter muscle at the lower end of the oesophagus.
A special form of diaphragmatic hernia occurs when the lower part of the oesophagus remains in the abdomen but parts of the upper stomach push into the chest cavity. This form of diaphragmatic hernia is the paraoesophageal hernia. In most cases, however, a mixed form of axial and paraoesophageal hernia is observed.
Patients with chronic reflux symptoms, i.e. constant acid regurgitation, are often diagnosed with a hiatal hernia, which can be identified as the actual cause of the reflux symptoms.
A gastroenterologist can recognise the hiatal hernia as such in the course of a gastroscopy and define approximately how big the hiatal hernia is. In addition, the gastroenterologist can also assess whether the axial diaphragmatic hernia can be repositioned, i.e. whether the oranges pushed by the hernia can be pushed back to their anatomically correct position.
A contrast swallow X-ray can visualise the phenomenon of diaphragmatic hernia even better and is one of the preferred methods in imaging techniques. The patient takes small sips of contrast medium while standing, which makes it possible to understand the movement and function of the oesophagus. It is also possible to visualise where the diaphragmatic arch is in different postures, for example when standing and lying down. With these diagnostic methods, axial gleithernias can also be detected well. In the concrete picture, this can look like this: when standing, the stomach pulls the diaphragmatic hernia downwards, but when lying down, the diaphragmatic hernia becomes visible in a swallowing view.
Often the medical language here is a little confusing. Especially in the definition of diaphragmatic hiatus as the passage of the oesophagus into the abdominal cavity and the actual diaphragmatic hernia, misunderstandings often arise regarding the size of the hernia itself. Other examinations measure the distance between the diaphragmatic passage and the entrance to the stomach to determine the size of the hernia.
Another possible examination is a pressure measurement in the oesophagus, also called manometry or oesophageal manometry. In this procedure, a thin probe with several pressure sensors is pushed through the patient’s nose into the oesophagus and into the stomach. The patient is given water in small sips and the movement of the oesophagus is recorded very precisely by the highly sensitive pressure sensors. If the act of swallowing as such is completely normal and powerful, one speaks of normal oesophageal function. -depending on how many of the swallows administered are completely normal, the functionality of the oesophagus can be normal, weakened and severely weakened. Especially for surgeons, a clear statement about the effectiveness or ineffectiveness of oesophageal function is crucial for choosing the most appropriate surgical methods.
Medical care for diaphragmatic hernias
Most diaphragmatic hernias are not even noticed by the patients themselves. In this case, therapeutic treatment is usually not necessary. A hiatal hernia is often only diagnosed in connection with reflux symptoms, but it does not always have to be treated surgically.
When is surgical treatment of a diaphragmatic hernia necessary?
A diaphragmatic hernia as an incidental finding in patients without reflux symptoms in the size of one to three centimetres does not need to be treated surgically. However, if the patient has reflux symptoms, an existing diaphragmatic hernia is always corrected in the course of reflux surgery. You can find out when reflux surgery is useful and necessary in the Swiss1Chirurgie information material on the website www.swiss1chirurgie.ch. The need for reflux surgery can also be clarified during an appointment at a Swiss1Chirurgie clinic in Bern, Brig or Solothurn.
It should be noted that reflux can also be treated with medication, but only the symptoms are treated and not the causes. If, despite taking reflux medication, infections of the oesophagus are detected or the symptoms of acid regurgitation do not subside, it is advisable to consult a specialist surgeon at Swiss1Chirurgie or the Gastroenterology Group Practice GGP in Bern.
A minimally invasive, so-called laparoscopic operation, as a reflux operation or, if applicable, as a hiatus hernia operation can then be the appropriate therapy.
For diaphragmatic hernias of four to seven centimetres in size, surgical correction of the diaphragmatic passage by means of net insertion will be the most practical and best solution. Depending on the findings, a slow or fast absorbing net can be used. It is also possible to place a permanent net that closes the hiatus correctly. Permanent nets are only justified in hiatus surgery in absolutely exceptional cases, as such nets can lead to tissue adhesions or adhesions that can impair the functionality of the diaphragm or the diaphragmatic passage.
The experts at Swiss1Chirurgie also rely on the Bard nets for the treatment of larger diaphragmatic hernias. As one of only a few clinics in Switzerland, Swiss1Chirurgie can dispose of slowly absorbable nets that reinforce the hiatus for a period of ten to 18 months and thus safely close the diaphragmatic hernia. During this time, the tissue can completely replace itself with a scar plate. A recurrence of the diaphragmatic hernia then occurs only very rarely.
With a hernia size of seven centimetres or more, the probability of a new diaphragmatic hernia, i.e. a recurrent hernia, is relatively high at over ten percent. That is why Swiss1Chirurgie attaches great importance to a well-structured and regular follow-up of patients after surgery for a diaphragmatic hernia. Even in the case of minor recurring hernias, the necessary corrections are then made again to avoid a major hiatus hernia.
If you have already had a hiatal hernia or paraoesophageal hernia corrected surgically and are not satisfied with the result, you are welcome to visit a Swiss1Chirurgie clinic in Bern, Brig or Solothurn. Our experts take your complaints seriously and work with you to make initial assessments for further treatment.
For further questions about diaphragmatic hernias in general and the therapeutic options and surgical methods, please feel free to contact the specialists at Swiss1Chirurgie. In addition, we provide further information material on our website www.swiss1chirurgie.ch. You can also use the contact options at www.swiss1chirurgie.ch or call one of our clinics.
Thank you for your interest and for your attention!
This podcast is part of the Helvetius.Life podcast series.
Helvetius.Life is the in-house newspaper of Helvetius Holding AG.This is where Swiss1Chirurgie, the Centre for Bariatric Surgery ZFBC, the Gastroenterology Group Practice GGP and the Bern Clinic PZBE combine their expertise and services in the interests of our patients’ health.
With Helvetius.Life we inform you about exciting topics from the specialist areas of the clinics and practices, provide insights into the work of specialists, show you what we can do in patients’ testimonials and present new findings, therapies and scientific research results.
In the USA, the US Preventive Services Task Force has come out with a recommendation for earlier bowel cancer screening from the age of 45. According to the study, the risk of severe to fatal colorectal cancer increases significantly, which clearly underlines the sense of screening for colorectal cancer before the age of 50. Accordingly, not only patients at risk, for example those with obesity, but also other groups are affected.
In the wake of the COVID19 pandemic, the problem of unnoticed regular screening is intensifying, which is likely to develop as a time bomb with a fuse of up to ten years.
The specialists of Swiss1Chirurgie and the Gastroenterological Group Practice GGP Bern point out the importance and great benefit of regular preventive examinations. In view of the developments in the USA and beyond, this should not only become more of a focus for people over 50, but also open up the discussion for universal pension provision from the age of 45 in Switzerland. The counselling service offered by Swiss1Chirurgie and the Gastroenterology Group Practice GGP takes this topic extremely seriously and provides important information on bowel cancer screening.
Read more about the recommendation of the US Preventive Services Task Force and the position of Swiss1Chirurgie and the Gastroenterological Group Practice GGP in the detailed article.
“This is a time bomb with a ten-year fuse”.
The US Preventive Services Task Force recommends colorectal cancer screening starting at 45
When the US news channel CNN reports in detail, it is on issues with implications. This is also the case in a report dated 18 May 2021, which deals in detail with the recommendation of bowel cancer screening from the age of 45.
Until now, at least in the USA, screening for colorectal cancer was recommended from the age of 50. If one follows the research results and the statements of renowned medical specialists on the subject, then bowel cancer diseases are reaching more and more people, including younger people. Accordingly, the lowering of the recommended age was only a question of common sense and forward-looking care.
The US Preventive Services Task Force is the leading advisory body on medical issues in the US and had already presented the draft of this recommendation in October 2020. The final version now available suggests that all people aged 45 to 75 years should be screened for colorectal cancer.
The reasoning
In a detailed justification, the makers of the recommendation explain that with colorectal cancer screening from the age of 50, about 50 cases in a number of 1,000 persons could be detected and avoided and, in addition, 25 deaths could be prevented.
Lowering the recommended age for colorectal cancer screening from 50 to 45 could effectively achieve two to three more cases of colorectal cancer and at least one death over and above the numbers achieved so far, he said.
This is the assumption of Dr Michael Barry, who, as vice-chairman of the US Preventive Services Task Force, has spoken to CNN on the subject.
Bowel cancer is the third most common cause of cancer deaths
This is true at least for the USA, but is also likely to be the case internationally. If you follow the figures in the USA, it is predicted that around 53,000 people will die of colorectal cancer in 2021, and the trend is rising. It is noteworthy that about 10.5 percent of newly diagnosed colorectal cancers occur in people under the age of 50. In the first 15 years since the turn of the millennium, cases have increased by a worrying 15 percent among adults aged 40-49. This, too, puts the US Preventive Services Task Force on alert to focus carefully on colorectal cancer at an earlier age.
Whereas colorectal cancer was previously mainly observed as a result of the risk factor obesity, the intestinal disease is increasingly affecting people who do not have such risk factors. Dr Benjamin Lebwohl, a gastroenterologist at NewYork-Presbyterian and Columbia University Medical Center, confirms this when he tells CNN: “To some degree, it can be driven in part by obesity, but there are many people younger than 50 who are not obese who develop colorectal cancer without any identifiable risk factors.”
American scientists and doctors have not yet been able to clearly define why cases of colorectal cancer are now also increasing in the age groups under 50. What is certain, however, is that cases can also be detected much earlier and treated more effectively through earlier screening.
The time bomb is ticking
What comes across here as an ominous scenario is justified when one takes a closer look at the figures. In 2018 alone, about 31 percent of eligible people in the US were not up to date on their colorectal cancer screening.
This number is likely to increase even further in the context of the Corona pandemic, as many adults are skipping the necessary screening examinations out of uncertainty, especially in the current phase. This is just as true in the USA as it is in Europe and Switzerland.
If one follows the opinion of Dr Michael Zinner, CEO and senior medical director of Baptist Health’s Miami Cancer Institute, it could be that “delayed screening due to Covid is a ticking time bomb with a ten-year fuse”.
Accordingly, doctors are increasingly urging their patients to catch up on bowel cancer screening examinations that they have not attended. The emphasis is that any test that has been done is always better than a test that has not been done.
Conclusions from the perspective of Swiss1Chirurgie and the GGP Bern
From the point of view of Swiss1Chirurgie and the Gastroenterology Group Practice GGP, bowel cancer screening has been the best and safest means of detecting and treating bowel cancer in good time for decades. Accordingly, attention should be paid to preventive examinations.
In Switzerland, too, this affects not only older women and men, not only people with certain risk factors such as obesity or a genetic predisposition, but practically every adult. From middle age at the latest, people should actively address this issue and talk about it with their family doctor or a specialist.
Although many developments from the USA only arrive in Europe and Switzerland with a certain delay, great vigilance must be maintained, especially in the case of colorectal cancer. To continue to wait here would allow the aforementioned time bomb to continue ticking and lay the extended fuse in this country as well.
The clear call is therefore to take advantage of the opportunities for bowel cancer screening in any case. And they do so regularly and even when there are individual concerns, such as during the COVID19 pandemic.
Professor (USC) MMM, FACS, FEBS (hon.)
In Switzerland, the recommendation is still to have a colonoscopy as a preventive examination from the age of 50. However, this does not apply to patients with stool irregularities, blood in the stool, chronic abdominal pain, or alternating diarrhoea and constipation, or relatives who have already had bowel cancer. If necessary, these patients should have a colonoscopy at an earlier stage so that changes can be diagnosed and treated in time.
Constant acid regurgitation is not only annoying, but can also cause serious secondary diseases. What is summarised in technical language as reflux is an extremely unpleasant restriction of the quality of life for those affected.
The LINX system has been available for years for reflux therapy and has led to extremely positive results. You can find out what LINX is, what LINX can do and how it works in the detailed article, in the video or on the Swiss1Chirurgie website.
Learn more about the reflux therapy procedure
There are probably around 20 percent of the population who regularly or chronically complain of reflux of stomach acid into the oesophagus. However, acid regurgitation is not only extremely unpleasant, but can also cause serious health problems, including oesophageal cancer.
With LINX, a system is available that can effectively prevent the backflow of gastric juice into the oesophagus. This system is used as part of a minimally invasive surgical operation. After placement of the LINX system, the symptoms subside and patients can return to a normal life in most cases.
What is LINX?
In principle, the LINX system is a magnetic ring chain. At first glance, the system can be compared to an elastic pearl necklace, whereby here the pearls are on magnets that are titanium-coated and thus completely harmless to the organism. Due to the attractive forces acting on the magnetic beads, they are repeatedly attracted to each other in the absence of counterpressure, which leads to a narrowing of the chain. When mechanical tension is applied to the system, the chain expands and widens the passage.
What can LINX do?
The LINX system is placed around the lower end of the oesophagus in a minor surgical procedure. The attraction of the titanium-coated magnetic beads creates a reliable closure of the oesophageal outlet without compressing the oesophagus. Only when, for example, a certain internal pressure is exerted on the oesophagus by the intake of food, does the magnetic ring open so that the food pulp or even liquids can enter the stomach unhindered. In this way, the normal function of the oesophagus is efficiently supported and the reflux of gastric juice into the oesophagus can be prevented. The bottom line is that LINX is strong enough to close the oesophageal junction into the stomach, but weak enough to allow air to escape from the stomach or vomiting to occur.
Practical experience
The LINX system has been known and proven for years. In the Swiss1Chirurgie clinics, this system is preferably used for reflux therapy whenever possible. The experience is extremely good, which includes that there are hardly any complications with the system during and after the surgical procedure. Since 2015, Prof. Dr. Jörg Zehetner has already treated over 250 patients with the LINX system. For most people with reflux symptoms, this system is the first choice, provided there is otherwise normal oesophageal function.
In order to assess this condition, a preliminary assessment of oesophageal function and reflux symptoms is essential. This preliminary examination includes a gastroscopy and a functional test of the oesophagus. Ideally, these examinations are supplemented by manometry, which means measuring the pressure in the oesophagus.
Would you like more information? Do you yourself have complaints due to acid reflux? Then watch the video with Prof. Dr. Jörg Zehetner, visit the Swiss1Chirurgie website or make an appointment at one of the Swiss1Chirurgie clinics in Bern, Brig or Solothurn.
Welcome to the new Swiss1Chirurgie podcast. In the current podcast of the Hernia Centre of Swiss1Chirurgie, we look at the topic of hernias today. The focus will be on inguinal hernias and therapy with the 3-D net.
My name is Jörg Zehetner. This podcast series is intended as patient information for those affected and all those who would like to deal with the topic of hernias.
First of all, it must be clarified what inguinal hernias are.
Inguinal hernias are weaknesses in the abdominal wall in which the abdominal wall tissue tears and organs behind it break through the abdominal wall completely or partially. In an inguinal hernia, this breakthrough through the abdominal wall takes place in the groin area.
Such hernias are mainly diagnosed in men. Women around the age of 50 can also be affected by hernias. Outwardly conspicuous are bulges in the groin area, which appear more or less clearly.
Now the question arises as to how hernias actually occur.
Inguinal hernias can already be observed in newborns. The reason for this is that in male babies, for example, the abdominal wall in the area of the spermatic cords has not yet closed completely. Such hernias are treated surgically after diagnosis in the first year of life.
In contrast to hernias in newborns, hernias in men are mostly seen between the ages of 40 and 50. Men aged 60 and over suffer most frequently from inguinal hernias.
Basically, the cause of every inguinal hernia, regardless of age or gender, is due to a weakness in the abdominal wall in the groin area.
How do inguinal hernias make themselves felt?
A hernia can often be suspected when there is persistent mild to moderate pain in the groin area. This pain can also be severe and stabbing. Often the pain radiates into the thigh and, in men, into the testicles. The pain is most noticeable when carrying heavy loads or as stabbing or pulling pain when working overhead.
If such pain is repeatedly felt in the indicated areas, a more precise diagnosis by the family doctor or the specialised specialist is recommended.
How are inguinal hernias diagnosed?
Experienced surgeons can already make a reliable diagnosis by palpating the groin area. In this procedure, the surgeon places his hand in the patient’s groin and makes him cough willingly. The coughing thrust causes the hernia to bulge in the affected region and can be felt.
It is worth noting that there are also hernias that are not reducible. This means that such hernias cannot be pushed back to their original position by applying light pressure. Then the bulges remain outside the abdominal wall, which not infrequently can also lead to incarceration.
Incarceration of a hernia is an acute complication and must be treated surgically immediately, if possible on the same day. Prolonged entrapment, especially of parts of the intestine, can significantly restrict or even completely stop blood flow to the organs. In the final consequence, this leads to considerable circulatory disturbances and even to the death of parts of the affected organ. This ultimately means a perforation, as a leakage, of the small intestine with life-threatening consequences. Such consequences are dangerous peritonitis and other serious complications. Partly because of these complications, hernias should always be taken very seriously, as they pose a serious threat to the health and, in extreme cases, the life of the patient.
In the case of rather asymptomatic hernias, which are neither noticed nor felt by the patient, it is possible to continue to wait and observe. However, if there is occasional stabbing or pulling pain in the groin area, a thorough examination by a specialist is also urgently required. This is the only way to reliably assess the urgency of further medical and surgical measures.
If the symptoms are unclear, which is often the case with very overweight patients, for example, the surgeon can use ultrasound examination in the groin area to make a more precise assessment of the disease pattern. An abdominal CT, i.e. a computer tomography of the abdominal area, or a magnetic resonance examination can also provide information about hernias that are not recognised or cannot be clearly diagnosed.
Inguinal hernias often occur on both sides. If there is a large hernia on one side, there is a good chance that there is a smaller or equally large hernia on the other side of the body. For this reason, both sides are always examined if an inguinal hernia is suspected, even if the hernia itself is initially only felt by the patient on one side. In this context, a bilateral correction of the abdominal wall is recommended, although the pain and discomfort may only be observed on one side.
The surgical treatment of inguinal hernias
Depending on the age of the patient, the size of the hernia, the general condition and the previous cardiological findings, an inguinal hernia is operated on either openly or laporoscopically, i.e. with a minimally invasive procedure.
Open surgery is preferred for very large fractures. This is also true if the fractures extend into the scrotum in men or if there is a previous cardiological condition. A recurrent hernia is also treated in an open operation. A recurrent hernia is a hernia closure operation that has already been performed, but was unsuccessful.
A laporoscopic correction of the inguinal hernia is the gentler therapy for primarily normal-sized inguinal hernias. This is a so-called keyhole operation, which is performed through quite small incisions.
Swiss1Chirurgie uses a unique technique in laporoscopic therapy. A small incision is made at the upper edge of the navel. A small camera is inserted through this opening behind the abdominal muscle on the right side. By forcing in CO2 gas, a space is created between the peritoneum and the abdominal muscle. In this way, the abdominal cavity can be excellently viewed in the direction of the groin and surgically evaluated.
Due to a special blunt surgical technique, nerves, tissue and veins can be well protected. Once sufficient space has been created in the groin area, the organs can be pushed back into their original position.
The nets are then inserted to close the openings in the abdominal wall. These nets reliably and permanently close the openings in the abdominal wall. For the nets, Swiss1Chirurgie relies on products from the company Bard, which are already three-dimensionally preformed. Hence the term 3-D net therapy. These ultra-light nets are offered in three sizes, so that practically all hernia sizes can be treated with them.
In addition to the sizes small, medium and large, the nets are also prepared for left-sided or right-sided use. The decision on which size to use is up to the operating surgeon and depends on the size of the hernia and the quality of the surrounding tissue.
Bard’s 3-D nets are made of a very light and non-decomposing polypropylene and are fixed to the abdominal wall by a special adhesive for small to medium-sized hernias. All surgeons at Swiss1Chirurgie use the same techniques.
Only in the case of large hernias is the net additionally fixed to the abdominal wall with polypropylene staples to reliably exclude slippage. Both the use of fibrin glue and the fixation with polypropylene staples enable quite painless therapies.
In the normal course of healing, the 3-D nets grow into the surrounding tissue so that long-term closure of the hernia can be achieved without the recurrent hernias already described.
Postoperative hernia therapy
Patients usually experience mild pain for about one to two days after the operation. After this time, the patients can usually already be discharged home. Painkillers in tablet form make the days after the operation easier and are adjusted individually.
After a hernia operation, it is important for patients to take it easy for about three weeks. During this time, sports, physical exertion, heavy lifting or stretching should be consistently avoided.
The surgical incisions on the skin are closed with self-dissolving glue or sutures so that normal body care and hygiene is possible immediately after the operation. Showering is also no problem with it. However, bathing and swimming should be avoided for at least two weeks.
What is the risk of suffering the same hernia again after such an operation?
This question is asked by many patients. Thanks to the modern surgical techniques used and the fitting of a 3-D net hernia closure, the risk of a recurrence of an inguinal hernia at the operated position is virtually eliminated. Only about one percent of the patients treated in this way will have a similar inguinal hernia again. This means that 99 out of 100 appropriately treated patients can live free of symptoms and complaints. This means that the success rate is extraordinarily high and the risk of a recurrence of a hernia is minimal.
If you have already been treated for inguinal hernia in another clinic or hospital outside of Swiss1Chirurgie and continue to suffer from pulling or stabbing pain, we recommend that you visit one of our practices. This allows us to make a second professional assessment of your specific situation. However, most hernias that have been treated surgically do not require follow-up by the general practitioner or specialist.
Thus, after about three weeks after the operation, patients can again bear a normal load and in most cases can also return to full professional life.
For further questions about inguinal hernias and the therapeutic options, please feel free to contact the specialists at Swiss1Chirurgie. To do so, use the contact options at www.swiss1chirurgie.ch or call one of our clinics.
Thank you for your attention!
This podcast is part of the Helvetius.Life podcast series.
Helvetius.Life is the magazine of Helvetius Holding AG.This is where Swiss1Chirurgie, the Centre for Bariatric Surgery ZFBC, the Gastroenterology Group Practice GGP and the Bern Clinic PZB combine their expertise and services in the interests of our patients’ health.
With Helvetius.Life we inform you about exciting topics from the specialist areas of the clinics and practices, provide insights into the work of specialists, show you what we can do in patients’ testimonials and present new findings, therapies and scientific research results.
Welcome to the fifth part of our podcast series on hernias. In this podcast from the Hernia Centre at Swiss1Chirurgie, we look at the topic of rare hernias of the abdominal wall today.
The podcast was based on an idea and text by Prof. Dr. Jörg Zehetner. Jörg Zehetner is, among other things, the owner of Swiss1Chirurgie and attending physician at the Hirslanden clinic Beau-Site.
This podcast series is intended as patient information for those affected and all those who are concerned with the topic of hernias, here especially with rarely occurring hernias of the abdominal wall.
In previous podcasts we have looked at inguinal hernias, abdominal wall hernias and dwarf skin hernias. The fourth podcast in the series focused on the surgical treatment of hernias with nets. If you have already listened to these podcasts, you already know what is meant by a hernia. These are always ruptures in the tissue, which cause internal organs to move completely or partially out of their physiologically correct position. This can be associated with more or less severe pain. Depending on the specific fracture, the blood and oxygen supply to the affected organs may be impaired or completely interrupted, which under unfavourable circumstances can lead to the death of the organ parts in the hernia sac and endanger life.
In addition to the abdominal wall hernias already discussed, there are also rarer manifestations of abdominal wall hernias. Such rarer forms are often only detected by a computer tomography of the abdominal cavity. A gastric resonance examination can also provide information about the presence of an abdominal wall hernia, which cannot be detected with the conventional options of palpation after a corresponding pain pattern of the patients.
A targeted examination of the abdominal wall using ultrasound can also occasionally detect one of the rare forms of abdominal wall hernia. Especially in the lower abdomen, the rare form of a Spieghel hernia is often diagnosed. This special form of hernia is named after its special location.
The posterior fascial sheet of the abdominal muscles ends midway between the belly button and the pubic bone. There may be a gap in the posterior fascial sheet or a hernia sac may slip in between the posterior fascial sheet and the abdominal muscle. Parts of the small intestine can also be trapped in this hernia sac.
Diese Sonderform des Spieghelbruchs ist von außen nicht tastbar, verursacht aber die gleichen Probleme wie der klassische Bauchbruch. Accordingly, surgical treatment will also be necessary for this form of abdominal hernia.
Another special form of abdominal wall fractures can be lateral fractures. These are located in the flank or even further back in the lombar area. Such fractures occur more frequently after open kidney surgery. Such hernia gaps are more difficult to treat than hernias in the anterior abdominal wall due to their anatomical location. Due to the rotation in the movement of the upper body, strong forces occur, which makes the surgical treatment of such rare fractures with mesh insertion rather difficult. Although a net insert can be used to close the hernia gap, it can also noticeably restrict mobility.
The treatment of such rare fractures requires true specialists who have sufficient experience in the surgical technique and operation of such fractures.
Special forms of hernias also occur on the diaphragm. This already involves the correct diagnosis of deviations in the diaphragmatic gap. Abnormalities are often misjudged and not diagnosed as a diaphragmatic hernia. Even in the course of a computer tomography, these special diaphragmatic hernias are often overlooked. The result is that the patients’ suffering is sometimes prolonged by years. Sometimes it is only laparoscopic diagnosis that leads to the discovery of such diaphragmatic hernias.
The form of hernia known in medical parlance as rectus diastasis is also one of the special forms of hernia. Here the midline between the straight muscle strands of the abdominal muscles is clearly widened. This physiological phenomenon occurs especially in women during pregnancy. Such phenomena can also be observed in severely overweight patients.
Due to the increased pressure on the abdominal muscles, the abdominal muscles are overstretched and give way. A weakening of the muscles in the midline then leads to a separation of the muscle strands up to the width of the hand.
Such fractures can be recognised when the patient lies on his back and lifts his head. Then a tent-like structure appears in the area of the navel, which appears as a bulge. This bulge is called a rectus diastasis. The patients hardly complain about pain. The softening of the abdominal muscles can be felt by the experienced surgeon. Since this is not a classic hernia and those affected are mostly pain-free, there is also no need for surgical intervention. At best, cosmetic considerations may lead to rectus diastasis correction. If minor hernias occur on the abdomen in the midline together with rectus diastasis, both symptoms can be corrected surgically.
The Swiss1Chirurgie experts have also learned the latest methods and techniques of surgical intervention in the special forms of hernias and have tested them over many years. One possibility of surgical intervention is the placement of sutures that bring the abdominal muscles back into the correct position. A net insert stabilises the tissue and supports the healing process. Doubling the anterior fascia sheet at the midline also corrects the defect successfully and sustainably. By means of a net insert, any gaps that may exist are also closed here. Such an operation can be performed openly, minimally invasively or as a laparoscopic procedure.
Occasionally, the “DaVinci” surgical robot is also used for such interventions. Whether and how robot technology is used in surgery is always decided by the operating surgeon in a preliminary discussion with the patient.
In the case of very complex abdominal wall hernias or larger hernia gaps, the Swiss1Chirurgie experts always work together with plastic surgeons. In this way, an optimal result can be achieved for each patient.
Should you wish to obtain a second opinion in connection with particular forms of hernia, the experts at Swiss1Chirurgie in the Hernia Centre are recommended as your professional contacts. This also applies if you wish to work with a plastic surgeon for a hernia operation or have already spoken to a plastic surgeon about or planned a hernia operation.
Even if the results of an operation already performed are not satisfactory, we will be happy to talk to you and recommend the next steps to correct the surgical procedure.
In overweight patients or older patients with weak tissue structures or risk factors such as heart disease, as well as in smokers and diabetics, even the best surgical techniques are always associated with an increased risk. A generally healthy lifestyle reduces the risks. Sufficient sport and exercise, a healthy diet and a mindful approach to one’s own health are ways to significantly limit the risks regarding abdominal wall hernias and also to reduce the risks of surgery.
We recommend that you take our online health check on our website at www.swiss1chirurgie.ch. This will give you valuable information about your current state of health.
For patients with a body mass index above 35, targeted weight loss is always recommended before surgery. Ideally, a weight below body mass index 30 is achieved before surgical correction of a large abdominal wall hernia is performed.
The specialists at the Centre for Bariatric Surgery ZfbC in Berne will be happy to make recommendations for any bariatric surgery that may be required. All services offered are subject to the strict criteria of the Swiss Working Group for Overweight Surgery SMOB. The results of any bariatric surgery are recorded and documented.
If you have any further questions about surgical intervention options, surgical techniques and methods or general therapeutic options, please feel free to contact the specialists at Swiss1Chirurgie. In addition, we provide further information material on our website www.swiss1chirurgie.ch. You can also use the contact options at www.swiss1chirurgie.ch or call one of our clinics.
Thank you for your interest and for your attention!
This podcast is part of the Helvetius.Life podcast series.
Helvetius.Life is the in-house newspaper of Helvetius Holding AG.This is where Swiss1Chirurgie, the Centre for Bariatric Surgery ZFBC, the Gastroenterology Group Practice GGP and the Bern Clinic PZBE combine their expertise and services in the interests of our patients’ health.
With Helvetius.Life we inform you about exciting topics from the specialist areas of the clinics and practices, provide insights into the work of specialists, show you what we can do in patients’ testimonials and present new findings, therapies and scientific research results.
Anyone who has ever taken a closer look at the topic of “losing weight” will sooner or later have come across the recommendation of a high-protein diet. Supermarkets are full of modern and mostly expensive high-protein products aimed at both athletes and people who want to lose weight. But can these products really help, is a high-protein diet good for weight loss at all and isn’t there something better? This medical article by Helvetius Holding AG, which is also available as a podcast in several languages on Deezer and Spotify, explains this.
Why a high protein diet?
From a scientific point of view, a higher protein diet can indeed be useful for losing body weight. If the diet contains more protein, however, the proportion of carbohydrates and possibly fats must decrease at the same time. Otherwise, the calorie content would be too high and the body would gain even more weight. A high-protein diet is suitable for weight loss, as proteins are very filling. Secondly, it leads to weight loss really coming from a lower body fat percentage. If the calorie intake is only reduced by eating less of all nutrients, the body will mainly lose muscle mass. The body also needs protein to build muscle, which is also part of a comprehensive weight loss strategy.
Are high-protein products from the supermarket a good idea?
Many of the high-protein products contain little or no more protein than simple dairy products such as low-fat curd cheese, cream cheese or natural yoghurt. For some of the products, the main difference is only the higher price for the high-protein marketing. Other products are loaded with other ingredients such as sweeteners or flavourings that are solely for taste and are often unhealthy. High-protein products are therefore not always worthwhile as a high-quality source of protein; the price-performance ratio in particular is often not right here.
Which foods provide enough protein?
Ideal sources of protein in a healthy diet are dairy products, fish, eggs and pulses. Nutrition experts advise that 1.2 grams of protein per kilogram of body weight should be consumed daily through food. Overweight people should base the amount of protein on their target normal weight and not on their current weight. Otherwise the calorie content is too high and losing weight does not work, because proteins also provide energy. It is also important to eat three meals a day and not all the time. Then the body has time in between to break down fat. Without these breaks, the insulin level in the blood does not drop and a high insulin level suppresses fat burning.
Protein-rich nutrition with taste
A sensible change of diet does not mean going hungry. Quite the opposite. Those who want to eat healthily can certainly do so with taste. For example, a gourmet cheese (such as Le Gruyère) is excellent as a tasty source of protein. Add a colourful salad with tuna or a vegetable mix with some lean meat and you have a healthy and delicious meal on the table.
If protein shakes, then the right ones!
In contrast to the high-protein products from the supermarket, some protein shakes can support weight loss as a so-called formula diet over a set period of time. In order for the weight reduction to be successful in the long term, a doctor should accompany the project. A nutritionist can make sure that a formulary diet really makes sense in the individual case and that suitable formulary products are used. Not every protein shake has an appropriate composition of the macronutrients protein, fat, carbohydrates and micronutrients such as vitamins and minerals. If other illnesses are already present or if medication is being taken, a doctor will also take this into account when planning the weight loss programme. He can also measure blood values and body fat percentage during the diet and optimise the formula diet plan if necessary. For example, in some cases, switching to a meal replacement strategy, where one protein shake replaces only up to two main meals per day, could help. In addition, a doctor makes sure that a formula diet does not last too long or too short and that the amount of energy taken in is suitable. If the dosage is too high, weight loss will fail, while if it is too low, hunger will not be satisfied sufficiently and the diet will not be followed through or the body will instead lose muscle mass.
Formula diet only with medical supervision
If the BMI is over 30 kg/m2, then no independent attempts at weight loss should be made: An appointment with a doctor is necessary. For a BMI over 35 kg/m2, the best option, after a detailed assessment, is bariatric surgery (obesity surgery). For patients in between, there is the possibility of conservative methods:Unfortunately, it is not easy to do all this on your own. Equally important is the long-term change in diet after the formula diet and more exercise. If both are missing, the yo-yo effect is already pre-programmed. Therefore, a doctor should also accompany the phase afterwards. So don’t just stock up on the next best protein shakes when you go shopping, but rather make an appointment with a doctor who specialises in obesity treatments. However, if you only want to lose a few kilos, you should focus on a healthier, somewhat calorie-reduced diet and more exercise. Formula diets are aimed more at people who are more overweight or have a fatty liver.
The protein shakes from Bodymed with weight loss programme
A good example of a weight loss programme with a formula diet is the Bodymed nutrition concept developed by doctors. It offers a medically guided course programme and matching protein shakes that have been put together according to scientific findings. The professional associations German Obesity Society (DAG), German Diabetes Society (DDG), German Nutrition Society (DGE) and the German Society for Nutritional Medicine (DGE). (DGE) and the German Society for Nutritional Medicine e. V. (DGEM) recognise Bodymed as an appropriate weight loss programme in their guidelines. (DGEM) recognise Bodymed as an appropriate weight reduction programme in their guidelines.
Nutrition is part of the aftercare for obesity surgery
Under certain conditions, it is hardly possible to bring the body mass index (BMI) into the normal range under one’s own efforts. Especially with a BMI over 35, an overweight operation such as a gastric bypass or the formation of a tube stomach may be advisable. However, this also means that patients have to be actively involved for the rest of their lives. So a healthier lifestyle and dietary changes are also crucial after obesity surgery. On the one hand, this is the only way to achieve sustainable weight loss. Secondly, there must not be any nutrient deficiencies, which can occur after obesity surgery due to the reduced food intake and the changes in digestion. Depending on the type of surgery, a deficiency of protein, calcium, zinc or vitamin B12, for example, is relatively common. Therefore, after such an operation, patients should compensate for a deficiency with appropriate dietary supplements and consume at least 60 grams of protein per day or 1.5 grams per kilogram of normal weight.
Professional support after obesity surgery
However, patients should not be left alone with this, because the changes in lifestyle and diet are very individual and have to be adjusted every now and then in the course of life. That is why professional aftercare is a high priority at the Centre for Bariatric Surgery ZfbC in Bern. In addition, complications can arise at any time and further interventions or other medical measures may be necessary. With good follow-up care, this is noticed early on and the treating doctors can react quickly.
The following also applies to a fatty liver: less carbohydrates and more protein
Many people associate fatty liver with excessive alcohol consumption. However, there is also the clinical picture of a non-alcoholic fatty liver, for which a wrong eating pattern and too little exercise are usually responsible. The body stores excess energy in the form of fat not visibly under the skin layers, but in the internal organs such as the liver. Therefore, although non-alcoholic fatty liver often occurs together with obesity, it does not always occur. In addition, a fatty liver can be the reason why weight loss attempts fail. A fatty liver leads to insulin resistance, which on the one hand promotes the storage of fat and thus weight gain. On the other hand, it can block the burning of fat. In order to successfully treat a fatty liver, first and foremost, those affected must do something themselves. Since, in addition to a lack of exercise, a diet too rich in carbohydrates and sugar in particular causes non-alcoholic fatty liver, the diet should contain fewer carbohydrates, more proteins and fewer calories overall. The principle is similar to losing weight. Here, too, those affected should seek professional help.
A healthy liver promotes a healthy life
Liver fasting with advice from the ZfbC
Liver fasting according to Dr. Worm with the Hepafast products from Bodymed is a good companion on the way to a defatted liver and, like the Bodymed programme mentioned above, is based on scientifically sound findings. The Hepafast products are specially formulated for liver fasting, which is why weight loss can certainly be a welcome side effect, but is not the primary goal. Individual medical advice on liver fasting according to Dr. Worm is very happily provided by every clinic within Helvetius Holding AG, of which ZfbC is one.
Where can I find more information about dietary changes and losing weight?
If you would like to find out more about a suitable diet for losing weight, after obesity surgery or for fatty liver, listen to our podcast and read the Helvetius.life newspaper. There, leading experts share their knowledge and explain, among other things, how you can successfully fight obesity and why this is so important in the first place. New scientific findings on the topics also have a firm place in it.
Conclusion: Cover your protein needs with pleasure and be accompanied by experts
When losing weight, it is helpful to pay attention to the protein content of the diet. High-protein products from the supermarket are not recommended, however. Instead, people who want to lose weight should get the amount of protein they need from simple dairy products, fish and pulses. For example, the daily consumption of a La Gruyère in combination with vegetables or salad can already make a good contribution to a protein-rich and healthy diet. In certain cases, protein shakes can also be useful. But then they should be products that are approved by doctors. These include the protein shakes from Bodymed. Regardless of whether the Bodymed programme is to lead to a BMI in the normal range, an overweight operation is necessary or the liver needs to be defatted, the doctors at the ZfbC provide individual advice and accompany you on your way to a permanent normal weight.
Information www.helvetius.events
Information events with live streams Medical expertise at first hand
Zermatt Zermatt: Backstage Hotel 18 June 2021 Colon infection: Prevent with diet(?)! J. Zehetner, MD 18 June 2021 Bowel cancer screening: who, when, how, where? MD I. Linas 18 June 2021 Follow-up after obesity surgery: Yes, but at the centre Dr med R. Steffen 18 June 2021 Integrative Medicine: Burn-out Treatment in the Mountain World Dr med. Th. Russmann
03 December 2021
Saas-Fee Saas-Fee: Saaserhof 16 July 2021 03 September 2021 10 December 2021
Kreuzlingen KREUZLINGEN: Talent-Campus Bodensee 22 October 2021
Helvetius Holding AG offers interesting specialist lectures on various topics at selected locations in Switzerland for referring physicians, medical laypersons and those affected. Conducted by Prof. Dr. Jörg Zehetner, these lectures not only offer in-depth knowledge from different focus areas, but also opportunities for further information. Disease patterns, diagnostic procedures and surgical techniques are presented as well as the forms of professional aftercare following surgical interventions. For those affected, such specialist lectures offer an increased degree of security before the planned intervention, and for those interested in medicine and doctors, the information events hold a plus in knowledge and experience.
Sources 1. https://www.aerztezeitung.de/Medizin/Daenische-Forscher-finden-die-optimale-Diaet-fuer-Uebergewichtige-216004.html (accessed 01.06.2021) 2. https://www.youtube.com/watch?v=5VRxhlfylTk (accessed 01.06.2021) 3. https://www.bodymed.com/gesundheitsprogramme/ernaehrung/ (accessed 01.06.2021) 4. https://www.ndr.de/ratgeber/gesundheit/Eiweiss-Shake-zum-Abnehmen-Worauf-kommt-es-an,formula100.html (accessed 01.06.2021) 5. https://www.nachsorge.ch/patientenzeitung-2021-helfetius-life/ (accessed 01.06.2021) 6. S3-Leitlinie “Prävention und Therapie der Adipositas”. German Obesity Society (DAG), German Diabetes Society (DDG), German Nutrition Society (DGE). (DGE), German Society for Nutritional Medicine e. V. (DGEM). Version 2.0 April 2014. 7. S3-Leitlinie “Chirurgie der Adipositas und metabolischer Erkrankungen”. German Obesity Society e.V. (DAG), German Diabetes Society e.V. (DDG), German Society for Nutritional Medicine e.V. (DGEM), German Society for Endoscopy and Imaging Procedures e.V. (DGE-BV), German Society for Psychosomatic Medicine and Medical Psychotherapy e.V. (DGPM), German Society of Plastic, Reconstructive and Aesthetic Surgeons e.V. (DGPRÄC), German College of Psychosomatic Medicine (DKPM), Association of Diabetes Counselling and Training Professions In Germany e.V. (VDBD), BerufsVerband Oecotrophologie e.V. (VDOE), Adipositaschirurgie-Selbsthilfe-Deutschland e.V. 8. https://www.aerztezeitung.de/Medizin/Eiweiss-laesst-das-Leberfett-schmelzen-301389.html (accessed 01.06.2021)
Welcome to the new Swiss1Chirurgie podcast. In this podcast from the Hernia Centre at Swiss1Chirurgie, we look today at the topic of abdominal wall hernias and their closure using a net insert.
My name is Jörg Zehetner. This podcast series is intended as patient information for patients and all those who are interested in the topic of hernias, especially abdominal wall hernias and their treatment with net inserts.
First of all, we would like to clarify at this point what abdominal wall hernias actually are.
Abdominal wall hernias are caused by a weakness of the connective tissue in the abdominal wall. Such abdominal wall hernias often occur as a result of surgical procedures in the corresponding area. Such abdominal wall hernias must be distinguished from those caused by a congenital tissue weakness in the abdominal wall or by regenerative processes in old age. Small gaps in the tissue structure of the abdominal wall approximately above and below the navel are conspicuous in any case.
The most common form of abdominal wall hernia is the umbilical hernia. In medical Latin, the umbilical hernia is called hernia umbilicalis et paraumbilicalis. Generally, there is a weakness in the abdominal wall around the navel in all people at birth. This is due to the physiological structure of the umbilical cord, which enables the placenta to supply the unborn child. After the actual birth, the umbilical cord is cut and the belly button is formed. It is precisely at this point that weaker tissue repeatedly develops, which makes an umbilical hernia possible in the later course of development.
Women in advanced pregnancy are particularly affected, and it is not uncommon for a large hernia to form due to the pressure from inside on the abdominal wall.
Abdominal wall hernias also occur more frequently after operations in the abdominal area, especially after open operations, because the abdominal wall that is separated during the operation causes a weakening of the tissue at these points.
In addition, abdominal wall hernias can occur in different places, for example on the left or right upper abdomen or in the area of the lower abdomen.
Manifestations of abdominal wall hernias
Smaller gaps in the tissue in these areas can cause the fat below the abdominal wall to protrude. Through somewhat larger gaps of about two to four centimetres, there is then already the danger that, for example, parts of the small intestine can be pressed through the abdominal wall.
Even larger hernias with a size of five to seven centimetres already cause more severe pain for those affected and therefore hardly go unnoticed. This is also because with such a size of hernia, the hernia sac, also known as the hernia sac, can already take on the size of a medium-sized apple.
A hernia of the abdominal wall is already very unpleasant due to the entrapment of organ parts and causes, above all, pulling pain.
This is always associated with the increased risk of small intestinal loops becoming trapped, as already mentioned. This means that the blood supply to these parts of the intestine is at least significantly restricted, if not interrupted, which can ultimately lead to the death of the affected organ parts. There is always the risk of peritonitis with the corresponding complications and even danger of death.
Treatment of abdominal wall hernias in the Swiss1Chirurgie clinics
The hernia experts at the Hernia Centre of Swiss1Chirurgie have been dealing with the treatment of abdominal wall hernias for many years. Very small abdominal wall gaps are treated here in a minimally invasive way. For this, only a small incision is made, which is then directly sutured again and provides sufficient strength in the abdominal wall tissue even without a net insert.
Larger abdominal wall hernias are treated more intensively. It always depends on the specific formation of the fracture, the age of the patients, the general state of health and existing previous findings of the patients. In many cases, laporoscopic surgery using small incisions is possible. Laporoscopic surgery using a net insert is a very gentle method that can be performed quickly, is not very stressful for the patient and usually has very good results.
Laporoscopic surgery
In laporoscopic surgery, a camera is inserted under the side of the abdominal wall through a small incision and allows a view of the existing tissue defect from the inside. The affected area of the abdominal cavity is filled with CO2 gas so that a sufficiently large surgical area is created. Minimally invasive surgical techniques are used to insert, position and fix the hernia net. These are two cuts about half a centimetre long.
The net serves to reinforce the abdominal wall from the inside. This means that further abdominal wall hernias in the corresponding areas can be ruled out very reliably for the future. This net is uncoated on one side so that it can bond and grow together well with the abdominal wall. The net is coated on the inside to reliably exclude the possibility of it growing together with the small intestine tissue.
In the treatment of abdominal wall hernias, Swiss1Chirurgie has relied for years on the hernia meshes of the Bard company, which have already proven themselves thousands of times in therapeutic treatment. Another advantage of these nets is that they are already equipped with a special fixation system, which makes it much easier to fix the nets to the abdominal wall and makes the minimally invasive operation even more bearable for patients.
The main advantage of these nets is that they can be placed very easily and precisely due to their special shape. The net itself is placed on a balloon structure and then positioned centred on the break. Inflating the balloon stretches the net open and ensures that it lies flat on the abdominal wall. This gives the hernia net a perfect position without major surgical effort. The net is then fixed to the abdominal wall at the edges. Afterwards, the balloon structure can be removed again. This positioning system described here is used exclusively by Swiss1Chirurgie in Bern. In this way, we were able to achieve consistently very good results with little postoperative pain for the patients.
The number of places where the net is attached to the abdominal wall varies depending on the size of the hernia. Experience shows that fewer fixation points also mean less pain for the patient. While permanent suture material was used in the past, the experts at Swiss1Chirurgie now use absorbable material that dissolves completely and without residue after eight to twelve weeks. If, for example, a nerve is hit during the operation, any pain that may occur will usually disappear after the absorbable staples are dissolved.
If abdominal wall hernias are treated in a large open operation, this often leads to very complicated healing processes with correspondingly difficult tissue adhesions. With minimally invasive procedures such as those we perform in the Swiss1Chirurgie clinics, such complications are ruled out from the outset, which significantly simplifies and shortens the healing process for patients.
Performance and follow-up of open surgery for abdominal wall hernia
If major open operations with corresponding adhesions have already been performed, we recommend a follow-up operation in which these complicated adhesions can be removed and further stabilisation of the abdominal wall can be achieved. The primary concern here is the closure of the affected abdominal muscles, where the posterior fascial sheet is usually affected. This can be closed well again with an appropriate follow-up operation and reinforced with a net. The remaining abdominal muscles are then precisely placed again.
With such an operation, which takes a little longer, the tissue adhesions can be removed and the function of the abdominal wall can be fully restored. It should not be concealed that such a major operation also involves certain risks due to its length of two to three hours. Depending on age, health condition and possible previous findings, inflammatory processes may occur in the area of the operated tissue, for example.
It is certain that such an open operation is associated with significantly more pain than the minimally invasive procedures. A stay of five to seven days in observation in hospital must be planned. The healing processes themselves also take longer than with minimally invasive surgery.
Depending on the surgical field, drains may also need to be placed to allow drainage of wound secretions as the tissue heals. In the case of major open surgery, an abdominal belt must always be worn afterwards to support the tissue. Together with the orthopaedic specialists, the surgeons at Swiss1Chirurgie have developed a belt with a special abdominal calotte. In complicated cases, it is even possible to produce an individual calotte using 3D printing. This allows the abdominal wall to be excellently supported, which is not always the case with prefabricated products.
Wearing such an abdominal belt will be necessary for about three to six weeks after the operation. Our recommendation is to wear the abdominal belt day and night for the first three weeks. For the following three weeks, the belt must only be worn during the day. Continuous monitoring and follow-up care takes place in the Swiss1Chirurgie clinics.
For further questions about abdominal wall hernias in general and the therapeutic options, please feel free to contact the specialists at Swiss1Chirurgie. In addition, we provide further information material on our website www.swiss1chirurgie.ch. You can also use the contact options at www.swiss1chirurgie.ch or call one of our clinics.
Thank you for your interest and attention!
This podcast is part of the Helvetius.Life podcast series.
Helvetius.Life is the in-house newspaper of Helvetius Holding AG. Here, Swiss1Chirurgie, the Centre for Bariatric Surgery ZFBC, the Gastroenterology Group Practice GGP and the Bern Clinic PZB combine their expertise and services in the interests of our patients’ health.
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