Hernia Podcast – Topic: Diaphragmatic hernias, hiatoplasty and fundopexy

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.

Our podcast series:

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We would also like to recommend our website

www.swiss1chirurgie.ch or our app, which you can also find at www.swiss1chirurgie.ch.

You can also find more topics and information at: hernien-podcast.ch, nachsorge.ch and in our in-house newspaper www.helvetius.life.

Podcast Topic: Inguinal hernias and modern 3-D net care

https://hernien.podigee.io/1-neue-episode/embed?context=external&theme=default

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.

We would also like to recommend our website

www.swiss1chirurgie.ch or our app, which you can also find at www.swiss1chirurgie.ch.

Podcast: Rare fractures of the abdominal wall

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.

https://hernien.podigee.io/5-hernien-podcast-5/embed?context=external&theme=default

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.

Podcast: Abdominal wall hernias, closure with net insertion

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.

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.

Our podcast series:

  • hernien-podcast.ch
  • adipositas-podcast.ch
  • ggp-podcast.ch

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You can also find more topics and information at: hernien-podcast.ch, nachsorge.ch and in our in-house newspaper www.helvetius.life.