Surgery of abdominal wall hernias

Hernias are orifices that form in the muscular wall where there are weak spots. Protuberances called hernial sacs can therefore form. These, however, are not always visible. Symptoms vary from simple discomfort to severe pain, but may be limited to a simple protuberance. Bowel loops can become strangled, which may lead to serious complications. In the event of a strangulation, emergency surgery is required. The only effective and definitive treatment is surgery. Depending on its location, a distinction is made between crural/femoral, umbilical or inguinal hernia. The latter is the most common form. However, hernias can also appear as a result of previous surgeries: these are called incisional/scar hernias. Unlike adults, young children do not always have to undergo surgery if they have an umbilical hernia as it can close spontaneously.

A hernia is diagnosed mainly in a hospital examination (palpation) by a (medical) specialist. In very rare cases, an ultrasound examination is indicated to confirm the diagnosis.

Hiatus hernia is another form of hernia: part of the stomach passes through the diaphragm into the chest cavity. The treatment of hiatus hernia is described in the reflux surgery chapter.

What is the preparation before surgery?

Depending on the patient’s medical condition, routine tests such as blood tests, blood pressure measurement and electrocardiogram or other tests may be necessary. 

How is the surgery performed?

The surgery is usually performed on an outpatient basis. There are two techniques. The first is to simply close the hernia orifice by sewing it together with thread. The second is to insert a mesh to strengthen the muscular wall. The latter technique is largely favoured because the rate of relapse/recurrence is significantly lower.

The surgery can be performed as an open procedure or by laparoscopy, a minimally invasive technique involving small holes through which the camera and instruments are inserted. This technique requires the injection of CO₂ to provide working space for the surgeon. The contents of the hernia, i.e. fat and/or intestine, as well as the hernial sac are returned/reduced to their correct position. A mesh is inserted between the peritoneum and the abdominal wall where it is sometimes fixed by glue or staples known as tackers. At the end of the surgery, the CO2 is evacuated and the skin is closed.

Laparoscopy is not as invasive, resulting in less post-operative pain and a shorter recovery time. However, it must be carried out under general anaesthesia, unlike the open route that can be carried out under general or partial (spinal) anaesthesia. The two methods cannot be used in all cases, however, and only the surgeon can assess which technique is most suitable for the patient. The trend is, of course, towards laparoscopy.

What is the treatment success?

The success rate is excellent as recurrence or relapse has become increasingly rare (1–2%) thanks to the use of mesh.  

What are the risks or complications of the treatment?

Hernia surgery is a routine intervention. As with all surgeries, bleeding, nerve damage, infections or adhesions may occur but are extremely rare. In males, a temporary swelling of the testicles may occur after surgery for an inguinal hernia. In very rare cases, the surgery may result in damage to the spermatic cord.

What happens after the surgical intervention?

As a rule, the patient is hospitalised for 1–2 nights after surgery. Sport and physical activity are usually possible after 3–4 weeks. The duration of the absence from work is adjusted according to the work involved and should be discussed with the surgeon.