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.