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New approaches in hernia surgery

This year the 41st international congress of the European Hernia Society took place in Hamburg. One focus was on new minimally invasive surgical techniques for treating abdominal wall hernias. In Germany, almost 100,000 abdominal wall hernias are treated surgically every year. These are usually scars or umbilical hernias.

Umbilical hernias occur frequently in the population and account for approximately 5% of all visceral hernias. In adults, these are usually acquired umbilical hernias, which are due to increased intra-abdominal pressure.
Umbilical hernias can occur particularly in women after pregnancy as part of a so-called postpartum abdominal wall syndrome. In addition to the umbilical hernia, there is also a more or less pronounced separation of the rectus abdominal muscles (diastasis recti). The syndrome can be accompanied by back pain, defecation disorders and stress incontinence.

Incisional hernias are breaks in the area of old surgical scars on the abdomen. This occurs after approximately 10% of all abdominal surgeries. Incisional hernias occur due to a lack of strength in the surgical scar. Favoring factors include wound infection, obesity, diabetes or smoking.

Fractures are primarily noticeable as swelling in the abdomen.
The hernia can contain fatty tissue, intestines and also parts of other abdominal organs.
Without surgery, there is an approximately 15% risk of intestinal entrapment in this gap in the abdominal wall over the course of your life. This situation is potentially life-threatening.
Fracture gaps between 3 – 4 cm seem to be particularly at risk here.

In its new guidelines, the European Hernia Society recommends that abdominal wall hernias over 1 cm in diameter should also be treated with a plastic mesh in order to minimize the risk of recurrence. Since the mesh must sufficiently overlap the fracture gap, large cuts are necessary with conventional methods. Of course, this also results in large scars.

MILOS is not only a beautiful island in Greece, but also describes a new technique developed in Hamburg (mini or less open sublay technique) to treat fractures with a plastic mesh through the smallest possible incisions. The fracture is exposed under general anesthesia using a small incision above the fracture. The mesh is placed on the peritoneum, behind the rectus abdominal muscles. The fracture gap is then closed over the plastic mesh. All that remains is a relatively small scar. Other advantages of this procedure include less pain after surgery, a lower risk of wound infections and very rapid resilience.

Since every patient is different, there is no surgical method that is equally suitable for everyone. The aim is always to be able to offer each individual a tailor-made surgical technique in the sense of a “tailored approach”.

I would be happy to take the time in my practice to inform you about the various therapy options and work with you to find the right one for you.

OA Dr. med. univ. Matthias Hofmann is a specialist in general surgery and visceral surgery, specializing in hernia surgery.