Frequently asked questions about hernias – understandable answers from the VenaZiel Hernia Center Berlin

FAQ: Inguinal hernia (inguinal hernia)

1 What is a hernia – and how can I recognize it?

An inguinal hernia is a condition. Tissue such as fat or parts of the intestine protrude from the abdominal wall. This happens due to a weak point in the abdominal wall. This weak point is located in the groin area. A palpable bulge develops, often accompanied by pulling or pain.

2. can an inguinal hernia resolve itself?

No. An inguinal hernia does not regress and can become larger or become trapped as it progresses. Surgery is the only permanent solution.

3 When is a hernia dangerous and an emergency?

Warning signs are:

• Suddenly severe pain,
• swelling that can no longer be pushed back,
• Nausea, vomiting or fever.

This may indicate an incarceration – an emergency!

4 What surgical methods are available for inguinal hernias – TAPP, TEP or open?

We offer many common procedures. The modern TAPP method in particular is minimally invasive. We also perform open surgery according to Lichtenstein and the TEP technique. We will clarify which method is ideal for you in a personal consultation.

5 Why do doctors often recommend the TAPP method for inguinal hernias?

The TAPP technique offers gentle and safe treatment. It is quick, even for bilateral fractures or after surgery. The pain is minimal and the downtime is short.

6 Who covers the costs of a hernia operation?

Yes, all of the procedures we perform are covered by health insurance. Additional requests (e.g. special mesh material or private rooms) are discussed individually.

7. how long will I be unable to work after a hernia operation?

After TAPP you are usually 3-5 days (for office work) – for physical activity after approx. 2-4 weeks. Sport is usually possible again after 4-6 weeks.

8. can an inguinal hernia operation be performed on an outpatient basis?

Yes – many hernia operations can be performed on an outpatient basis, provided there are no accompanying illnesses.

9 Why is a mesh used during hernia surgery – is it safe?

Yes – in adults, a fine-meshed, biocompatible plastic mesh is usually used, which remains in the body permanently. It stabilizes the abdominal wall and prevents relapses. Its safety has been scientifically proven.

10. what happens if I don’t have my hernia operated on?

If left untreated, the bowel can become trapped – with the risk of intestinal obstruction or even death. Chronic pain or restrictions in everyday life can also occur.

FAQ: Umbilical hernia (umbilical hernia)

1 What is an umbilical hernia and how does it develop?

An umbilical hernia (medical term: umbilical hernia) is an opening in the abdominal wall around the navel. Tissue can leak through this opening, usually fat or intestine. The result is a visible or palpable protrusion.

2. does every umbilical hernia in adults require surgery?

Not necessarily. Small, symptom-free umbilical hernias in adults can be observed. However, if there is discomfort, growth or risk of incarceration, surgery is recommended.

3 When does an umbilical hernia become dangerous – signs and symptoms?

Warning signs are: severe pain, hard swelling, nausea, vomiting or stool retention. These indicate an incarceration and constitute a medical emergency.

4 How long does it take to heal after an umbilical hernia operation?

As a rule, you will be able to work again after 1-3 weeks – depending on the surgical method and occupation. Physically strenuous activities should be avoided for 6 weeks.

5. can an umbilical hernia come back after the operation?

Yes, there is a risk of recurrence – especially with unfavorable scar healing or persistent pressure on the abdominal wall. Mesh implantation significantly reduces this risk.

6. umbilical hernia surgery on an outpatient or inpatient basis – which is better?

Small fractures can be operated on as an outpatient procedure. In the case of larger findings or risk factors, a short inpatient stay is recommended.

7 What are the costs of an umbilical hernia operation?

The costs are generally covered by statutory and private health insurance companies. If you require a specific technique (e.g. particularly high-quality mesh), additional payments may be required. We will be happy to advise you.

8. how can I prevent another umbilical hernia?

It is important to avoid being overweight, ensure good abdominal muscle tone, avoid heavy lifting, treat chronic coughs and keep the bowels healthy (avoid constipation).

FAQ: Femoral hernia (femoral hernia)

1. how do I recognize a femoral fracture?

Small femoral fractures often do not cause any clear symptoms at first. Pay attention to unusual pain in the groin or upper thigh, especially if it occurs during exertion. A palpable lump below the groin is an indication of a femoral hernia. If you are unsure, have yourself examined by a doctor – an ultrasound can provide clarity.

2. is a femoral fracture dangerous?

If left untreated, a femoral hernia can become dangerous because there is a risk of incarceration. In the event of an incarceration, for example, a piece of intestine becomes trapped in the hernia and the blood supply is interrupted – resulting in an acute emergency with severe pain.

Without timely surgery, this can lead to an intestinal obstruction or even life-threatening complications. You should therefore never take a suspected femoral hernia lightly.

The good news is that with early treatment (planned surgery), the risk of complications is minimal.

3. what is the difference between a femoral hernia and an inguinal hernia?

Both types of hernia occur in the groin area and are therefore easily confused. The inguinal hernia occurs directly in the groin and is very common in men, but rather rare in women.

A femoral hernia occurs below the groin on the thigh and mainly affects women. An inguinal hernia often feels like a pulling pain with a bulge in the groin, whereas a femoral hernia can lead to deeper pain in the thigh.

The decisive factor is that both hernias should be operated on, as both have a risk of incarceration. The surgical techniques are similar. Your doctor can determine which hernia is involved during an examination. Sometimes an inguinal and femoral hernia coexist (especially in older patients).

4. does every femoral fracture require surgery?

Yes, the only sensible treatment for a femoral hernia is surgery. Unlike some umbilical hernias, for example, which can remain small and asymptomatic, a femoral hernia almost always tends to worsen. Conservative measures (such as hernia bands) are not a permanent solution.

As a femoral fracture does not heal spontaneously and the risk of sudden incarceration is high, doctors advise surgery in practically all cases.

5 How is a femoral hernia operated on? Does the operation hurt?

The procedure is performed under general anesthesia so that you do not feel any pain during the operation. The surgeon puts the expelled abdominal contents back in place and reinforces the hernia site with a mesh to prevent the hernia from recurring.

Depending on the situation, this is done minimally invasively (keyhole surgery) through a few small incisions or openly through a slightly longer incision. Both methods take around 45-60 minutes. Thanks to modern anesthesia, you will wake up gently.

Wound pain may occur after the operation, but this is treated with painkillers. Many patients are surprised at how tolerable the discomfort after hernia surgery is today.

6. does the femoral hernia operation take place on an outpatient basis?

In our hernia center, yes. We usually perform thigh hernia operations on an outpatient basis. This means that you can go home on the same day. Outpatient surgery is possible because the procedure is relatively short and complications are rare. Of course, you will stay with us for a few hours for monitoring.

If an overnight stay is necessary for medical reasons (very rare), we will organize this for you – but this is not usually necessary. The advantage of outpatient surgery is that you can recover at home afterwards and do not have to stay in a clinic.

7 How long does the healing process take and when can I return to work?

The healing time depends on the surgical procedure and your personal constitution. In the case of minimally invasive surgery, many patients are able to return to work after one to two weeks, provided their job does not involve heavy lifting.

Physical rest (no heavy lifting, no straining) is recommended for about 4 weeks. Office work can often be resumed after 7-10 days, heavier physical work after approx. 4-6 weeks – discuss this individually with your doctor.

It is important to listen to your own body: start with light activities and increase slowly. Most everyday activities (walking, climbing stairs, light housework) are possible again after just a few days. You should only resume sports such as jogging or fitness once you have been cleared by your doctor (usually after 4-6 weeks).

8 What do I have to consider after the femoral hernia operation?

Avoid anything that puts pressure on the abdominal wall in the first few weeks: heavy lifting, intensive pushing during bowel movements (ensure soft stools, e.g. by eating a high-fiber diet), coughing vigorously (it is therefore advisable to stop smoking).

Care for the wound according to the instructions – keep it clean and dry, change plasters as recommended. Light showers are usually permitted after 2-3 days, bathing only after the wound is completely closed. If necessary, wear a special support bandage or bandage if prescribed by us. Listen to how your body feels: pain is a warning signal, do not overexert yourself. If redness, swelling or fever occur, contact us immediately.

As a general rule, the best way to recover after a femoral hernia operation is with sufficient rest, a balanced diet and moderate exercise in a pain-free environment – this is the best way to promote healing.

9. does the health insurance company cover the costs of the operation?

Yes, hernia operations are generally covered by health insurance as they are medically necessary procedures. If you are covered by statutory health insurance, you will be billed as usual by your health insurance provider (only the statutory co-payment will be charged, if necessary).

Privately insured persons receive an invoice in accordance with the scale of fees for doctors, which is usually reimbursed in full by the private health insurance company. If you are a self-payer, we will provide you with a cost estimate in advance. The preliminary examinations (consultation, ultrasound, etc.) are also covered by the insurance companies. Please do not hesitate to contact us if you are unsure about the costs – we will be happy to advise you in detail.

10. can a femoral hernia be prevented?

A femoral hernia cannot be prevented with certainty, but you can take some preventative measures. It is important to strengthen the connective tissue and not put unnecessary strain on it: maintain a healthy body weight, eat a diet rich in vitamins and minerals (for good collagen in the tissue) and do moderate exercise to strengthen the abdominal muscles.

Avoid chronic straining – a high-fiber diet or mild laxatives can help with constipation, while the cause of a chronic cough should be treated.

Lift loads with caution: preferably from a squatting position with a straight back to reduce the pressure on the groin. These measures can reduce the risk, but are no substitute for any necessary treatment of existing hernias.

If you have risk factors (e.g. weak connective tissue in the family), have yourself examined regularly – this way, a developing hernia can be detected early.

FAQ: Diaphragmatic hernia (hiatal hernia)

1 When does a diaphragmatic hernia need to be operated on – and when not?

No. Small hiatal hernias without or with mild symptoms do not necessarily require surgery. Conservative treatment with medication (for heartburn) and lifestyle changes is often sufficient. Surgery is particularly recommended if there are severe symptoms or a dangerous type of hernia (e.g. paraesophageal).

A paraesophageal hernia in particular should be operated on if you have symptoms, as there is a risk of incarceration. Your doctor will discuss with you individually whether surgery is necessary.

Remember: Not every diaphragmatic hernia needs surgery – but every large or problematic hernia should be examined by a specialist.

2 How is a diaphragmatic hernia diagnosed?

The diagnosis is usually made by gastroscopy and/or an X-ray. During the endoscopy, the doctor can see directly whether parts of the stomach have slipped upwards. The X-ray pre-swallow shows the size and shape of the hernia in real time.

In addition, pH-metry (measurement of acid reflux) and manometry (pressure measurement) can be performed to assess the influence of the hernia on the reflux. In unclear cases, a CT scan is also used, e.g. in cases of suspected incarceration. In most cases, however, endoscopy + X-ray are sufficient for the diagnosis.

3. does a hiatal hernia cause heartburn (reflux)?

Yes, that is very common the case. The hiatal hernia weakens the closing mechanism at the entrance to the stomach because the lower esophageal sphincter is displaced upwards into the chest cavity.

As a result, stomach acid can easily flow back into the esophagus, causing heartburn (reflux). Axial sliding hernia in particular often causes severe heartburn.

Many patients first notice their diaphragmatic hernia because they have chronic acid regurgitation. In other forms of hernia (paraesophageal), heartburn may also be absent, in which case mechanical complaints are the main symptom.

Overall: Reflux and hiatal hernia often occur together – up to 90% of people with chronic reflux have a (usually small) hiatal hernia.

4. how does a diaphragmatic hernia operation work – explained step by step

In most cases, the operation is minimally invasive (laparoscopic) performed. The patient is given general anesthesia. The surgeon inserts a camera and fine instruments through small incisions. First, the displaced part of the stomach is retracted into the abdominal cavity. Then the diaphragmatic gap is reduced, usually by a few sutures in the area of the hiatus (this is called hiatoplasty).

If necessary, a small mesh is attached for reinforcement. The surgeon then often forms a fundoplication – i.e. a gastric sleeve around the oesophagus to improve the closing mechanism. Once everything is in place, the instruments are removed and the small incisions are closed. The operation usually takes 1-2 hours.

In difficult cases or emergencies, open surgery may be performed (longer abdominal incision), but this is rare. After the operation, the patient wakes up from the anesthetic and remains under observation. Overall, the procedures very safely and routinely in specialized centers.

5 What are the risks of hiatal hernia surgery?

As with any surgery, there are certain risks. These include: Injury to neighboring organs (esophagus, stomach, rarely spleen) – but very unlikely with experienced surgeons. Bleeding or secondary bleeding can occur, but can usually be controlled.

Infections in the wound area or in the abdominal cavity (peritonitis) are rare, as the procedure is minimally invasive and the gastrointestinal tract is not opened. Specifically, swallowing difficulties can occur after fundoplication if the cuff is too tight – this can be remedied by endoscopic dilation or, in rare cases, re-operation. It is very rare for the cuff to slip down again prematurely or for a Recovering hernia elsewhere.

Thrombosis or pulmonary embolism are general surgical risks, but prophylactic injections are given to prevent this. The mortality rate for planned hiatal hernia surgery is extremely low ( <<1 %). Overall, the operation is considered safe. Your surgeon will go through all the risks and complications with you during the consultation.

6 How long does it take to heal after a hiatal hernia operation?

The initial healing of the internal sutures on the diaphragm takes about 6 weeks. During this time you should take it easy (no heavy loads, as described above). Superficially, the small incisions will heal within ~2 weeks.

Many patients already feel quite fit after 1-2 weeksespecially in the case of laparoscopic surgery, and can take up lighter activities. Full weight-bearing capacity (sport, lifting) is usually restored after 8-12 weeks when the scars are stable under load.

It is important to build up the diet slowly – after approx. 4 weeks you can eat normally again once everything has healed well. A certain amount of caution when swallowing (chew well, small bites) is advisable for about 2-3 months until everything has healed soft and scarred internally.

Your doctor will usually schedule a follow-up appointment ~6 weeks post-op to check on the healing process. Many people report that from then on they almost forget that they have had surgery – except that the heartburn is gone.

7. can a hiatal hernia come back after surgery?

Yes, there is always the possibility of a recurrence. Despite careful surgery, a diaphragmatic hernia can recur in around 10% of patients within 5-10 years.

Reasons can be: Tissue weakness (the original cause persists), persistent high pressure (e.g. heavy pressing, renewed weight gain) or, in a few cases, failure of the material (suture tears). However, not every small recurrent hernia leads directly to symptoms.

Many recurrences are asymptomatic and are only discovered by chance. However, if symptoms recur (recurring heartburn, feeling of pressure), this should be investigated. Minor recurrences can initially be treated conservatively. In the case of larger or symptomatic recurrences, revision surgery is possible – often minimally invasive, sometimes also robot-assisted.

The chances of success with a second operation are also good, although somewhat lower than with a primary operation. It is important to minimize risk factors after the first operation (no smoking, normal weight, no heavy lifting) in order to prevent a recurrence as far as possible.

8. what can I do myself to alleviate the symptoms?

A few things! Lifestyle changes can make a big difference, especially for mild heartburn caused by hiatal hernia. Losing weight is essential if you are overweight – just 5-10 kg less can significantly improve reflux.

Eat a reflux-friendly diet: Eat less fat, don’t eat too much at once, eat earlier and lighter in the evening. Avoid triggers such as alcohol, nicotine and coffee in excess. Sleep with your head elevated if you suffer from heartburn at night.

Avoid pressing – Treat constipation early (fiber, drink plenty of fluids). Lift heavy things from your knees, not from your back with forced breathing. For acute symptoms, over-the-counter antacids (such as Maaloxan) can provide short-term relief – but if the problem persists, please consult a doctor.

Physiotherapy or special breathing exercises can strengthen the diaphragm muscles and thus indirectly support them. Ultimately, by adopting a healthy lifestyle, you can ensure that the Hiatal hernia causes as few symptoms as possible.

Although this does not replace any necessary surgery, it can delay the time or make an operation superfluous if the symptoms disappear.

FAQ: Incisional hernia (incisional hernia)

1 What is an incisional hernia and what causes it?

An incisional hernia is a hernia in an old surgical scar. After abdominal surgery, the scar can form a weak point through which tissue or intestine protrudes. Common triggers are impaired wound healing, too early weight bearing after the operation, obesity or congenital weakness of the connective tissue. The combination of these factors means that the scar cannot withstand the internal pressure and a hernia forms.

2. how do I notice that I have an incisional hernia?

A typical symptom is a soft protrusion on the former surgical scar, which is particularly noticeable when standing or pressing (coughing, lifting). This is often accompanied by a pulling or pressure sensation in this area. If you notice such a bump, which may disappear when you lie down, you should consult a doctor. If you experience sudden severe pain, redness or nausea at a scar site, you should suspect an incarceration – in this case, go to hospital immediately!

3. is an incisional hernia dangerous?

In itself, an incisional hernia is not usually life-threatening, but it can enlarge and cause increasing discomfort. The greatest danger is the incarceration of parts of the intestine in the hernia. This interrupts the blood supply to the intestine – an acute emergency that requires immediate surgery. If left untreated, an incarceration can lead to intestinal obstruction or death. An incisional hernia should therefore not be taken lightly.

4. does every incisional hernia require surgery?

In most cases, surgery is recommended as this is the only way to permanently close the cause – the gap in the abdominal wall. Without surgery, the hernia usually enlarges over time. Surgery is particularly recommended if you are in pain or the hernia is getting bigger. Only in a few cases (very small, asymptomatic hernia and high risk of surgery) can you wait and see. Even then, regular check-ups are important. In the long term, however, incisional hernia surgery is the only curative treatment.

5 How is an incisional hernia operated on?

The standard procedure today is to reinforce the abdominal wall with a synthetic mesh. The operation can often be minimally invasive (laparoscopic): The surgeon makes several small incisions, inserts a camera and places the mesh on the hernia site from the inside. In the case of larger incisional hernias or certain situations, surgery must be performed in an open procedure. Even then, a mesh is usually sewn in to ensure stability. The exact surgical method depends on the size and location of the hernia as well as your individual factors, which will be discussed with you in advance.

6 What anesthesia is required for hernia surgery?

Most incisional hernia operations are performed under general anesthesia so that you are absolutely pain-free and the abdominal wall is completely relaxed. In some cases, surgery can also be performed under partial anesthesia (spinal anesthesia) or local anesthesia – the latter especially for smaller hernias and open techniques. Our anesthetists will discuss the safest and most comfortable solution with you.

7 How long does the procedure and hospital stay take?

An uncomplicated incisional hernia operation usually takes between 45 minutes and 2 hours, depending on the size of the hernia and the surgical method. Thanks to our outpatient concept, you can usually return home on the same day. In total, you will only spend a few hours at our surgery center, including preparation and recovery. This eliminates the need for a longer stay in hospital.

8. will I have severe pain after the operation?

Thanks to modern, gentle surgical techniques and effective pain therapy, the pain after an incisional hernia operation is easy to control. You will be given painkillers immediately after the operation so that you feel very little pain. In the days afterwards, you will often experience soreness or aching muscles in your abdomen, but this can be easily treated with tablets. Many patients are surprised at how well the pain is tolerated – especially after laparoscopic surgery. It is important that you take the prescribed painkillers as required and take it easy physically.

9 What do I have to consider after the operation?

After an incisional hernia operation, you should take it easy physically for a few weeks. In particular, avoid heavy lifting (nothing over approx. 5-10 kg for the first 4-6 weeks, depending on your doctor’s instructions). Sports activities should also be resumed gradually and only after clearance from the doctor. The wounds must be kept clean and dry; you will be given detailed care instructions. At our Hernia Center, we will arrange follow-up appointments to monitor the healing process. We are also available at any time to answer any questions you may have or if any complaints arise.

10. when can I go back to work?

This depends on the type of work you do and the size of the hernia. In the case of predominantly sedentary work, many patients can return to work after 1-2 weeks, provided there are no complications. For physically demanding jobs or larger hernias, it may be necessary to take several weeks off work (up to 4-6 weeks). Your surgeon will give you a recommendation at the final consultation as to when you will be able to return to work.

11. does the health insurance company cover the costs of the treatment?

Yes, the treatment of an incisional hernia is a medically necessary measure and is generally covered by statutory and private health insurance. At VenaZiel Hernia Center Berlin, you can be treated as a statutory or private patient. Any co-payments (as is usual for outpatient operations) or formalities will be explained to you transparently in advance. So do not hesitate to postpone an examination or treatment for cost reasons – your health has priority and we will be happy to assist you with any questions regarding cost clarification.

12 How quickly can I get an appointment at the Hernia Center Berlin?

We will endeavor to offer you an appointment as quickly as possible. As a rule, you will receive a consultation appointment with our hernia specialists within a few days. If an operation is necessary, this can often be scheduled promptly – we do not have long waiting times like some large clinics. You can simply make an appointment by telephone or online (via our website). We will also find a quick solution for you in the event of acute problems.