Herniotomy, hernia surgery

Hernias are weaknesses or holes in the abdominal wall. They form protrusions, or hernia sacs. Apart from the visible protrusion, they sometimes cause no further symptoms. However, there is a risk that the intestinal loops will become trapped in the hernia sac and cause severe complications in the process. Hernias should therefore always be treated surgically. Depending on the location, a differentiation is made between inguinal hernias, femoral hernias and umbilical hernias. An inguinal hernia is the most common form. However, hernias can also occur in other places after earlier operations. Such hernias are known as incisional hernias. Unlike those in adults, hernias in small children are not always treated surgically. Sometimes, an incisional hernia recedes.

A special type of hernia is the hiatus hernia, during which part of the stomach shifts into the abdomen through the diaphragm. The treatment of the hiatus hernia is discussed in the chapter entitled reflux surgery.

What preparations are carried out before the procedure?

Hernias in the abdominal wall are usually diagnosed by palpating the area. Sometimes a further ultrasound is carried out to confirm the diagnosis.

All the usual pre-operative assessments are required, such as a blood test, blood pressure measurement and an ECG. A hernia operation can be carried out under general anaesthetic or with an epidural anaesthesia. Patients must have an empty stomach for the procedure.

How is the operation carried out?

The operation is usually performed on an outpatient basis. Basically, there are two ways to close a hernia: with a suture or by covering it with a plastic net. Nowadays, the latter is preferred as the recurrence rate is lower than with a simple suture closure.

The operation can be carried out as an open abdominal procedure or as a minimally invasive procedure with laparoscopy. Laparoscopy is generally less stressful on the patient, causes less postoperative pain and requires less recuperation. Many surgeons prefer it for this reason.

During the laparoscopic surgical procedure, entrance is gained over the hernia either from the abdominal cavity by piercing the peritoneum (transabdominal method) or without piercing the peritoneum (preperitoneal method). A laparoscope and surgical instruments are inserted over small incisions in the skin. Inflating the surgical area with CO₂ enables a better view and provides more space for the procedure. Firstly, the hernia sac with content is repositioned or pulled back (redeposited). Then a plastic net is inserted between the abdominal muscles and the peritoneum. During the transabdominal method, the plastic net has to be fixed to the abdominal wall. This is not necessary for the preperitoneal method. Finally, the CO₂ is release and the skin incisions are sutured.

What is the success rate of this procedure?

Hernia operations have a high success rate. They can reoccur sometimes; however, thanks to the method of laying a plastic net, they have become a lot less frequent.

What are the possible complications and risks of this procedure?

Operations on hernias in the abdominal wall are routine procedures. As with all surgery, the operation may occasionally lead to infections, nerve damage, post-operative haemorrhaging or growths. Temporary swelling of the testicles can occur after hernia operations, and in extremely rare cases, the spermatic cord in men can be injured.

What happens after the operation?

Patients are usually required to stay in hospital for one to three days after a hernia operation. Sport and heavy physical work can usually be taken up again after two or three weeks without any limitations.