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 where tissue, such as fat or parts of the intestine, protrudes from the abdominal wall through a weak spot in the groin area. This results in a palpable bulge, often accompanied by pulling sensations or pain.

 

2. can an inguinal hernia resolve itself?

No. An inguinal hernia does not regress and may become larger or incarcerated over time. 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 the open Lichtenstein operation and the TEP technique. We will determine the ideal method 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 hernias or after previous operations. 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) – after approximately 2–4 weeks for physical work. 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 synthetic mesh is usually used, which remains permanently in the body. It stabilizes the abdominal wall and prevents relapses. The safety has been scientifically proven.

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

If left untreated, it can lead to incarceration of the intestine – with the threat of bowel obstruction or even life-threatening conditions. Chronic pain or limitations 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, asymptomatic umbilical hernias in adults can be monitored. However, surgery is recommended if there are complaints, growth, or risk of incarceration.

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

Warning signs include: severe pain, hard swelling, nausea, vomiting, or constipation. These indicate incarceration and constitute a medical emergency.

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

In general, 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 hernias can be operated on an outpatient basis. For 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 desire a specific technique (e.g., particularly high-quality mesh), there may be additional costs. 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 hernias often do not cause clear symptoms at first. Pay attention to unusual pain in the groin or upper thigh, especially if it occurs with exertion. A palpable nodule below the groin is an indication of a femoral hernia. If you are unsure, have a doctor examine you – an ultrasound can provide clarity.

 

2. is a femoral fracture dangerous?

If left untreated, a femoral hernia can be dangerous because of the risk of incarceration. In the event of incarceration, a piece of intestine, for example, becomes trapped in the hernia and the blood supply is interrupted – this creates 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.

The femoral hernia occurs below the groin on the thigh and primarily affects women. Inguinal hernias often manifest as a pulling pain with a bulge in the groin, while femoral hernias are more likely to cause 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 ligaments) are not a permanent solution here.

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 about 45-60 minutes. Thanks to modern anesthesia, you will wake up gently.

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

 

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

In our hernia center, yes. We usually perform femoral hernia operations on an outpatient basis. This means 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 approximately 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 has completely closed. If necessary, wear a special support bandage or bandage if prescribed by us. Listen to your body: 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 companies, as they are medically necessary procedures. If you have statutory health insurance, billing is carried out as usual via your health insurance company (only the statutory co-payment is due, if applicable).

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.

This allows stomach acid to easily flow back into the esophagus – resulting in heartburn (reflux). In particular, axial sliding hiatal hernias often cause severe heartburn.

Many patients first notice their hiatal hernia because they have chronic acid regurgitation. With other forms of hernia (paraesophageal), heartburn may be absent; mechanical complaints are then the main focus.

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) carried out. 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. The diaphragmatic gap is then reduced, usually by a few sutures in the area of the hiatus (this is known as hiatoplasty).

If necessary, a small mesh is attached for reinforcement. The surgeon then often performs a fundoplication – i.e., a gastric wrap around the esophagus 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 minimally invasive techniques are used and the gastrointestinal tract is not opened. Specifically, swallowing difficulties may occur after fundoplication if the wrap is too tight – this can be corrected by endoscopic dilation or, in rare cases, re-operation. Very rarely, the wrap slips down again prematurely or 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 in 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 weeks, especially with laparoscopic surgery, and can resume lighter activities. Full load-bearing capacity (sports, lifting) is usually possible 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 (chewing well, small bites) is advisable for about 2–3 months, until everything has healed softly and with scar tissue internally.

Your doctor will usually schedule a follow-up appointment ~6 weeks post-op to check the healing process. Many report that they almost forget they had surgery from then on – 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., strong straining, renewed weight gain), or, in rare cases, material failure (seam tears). However, not every small recurrent hernia directly leads to complaints.

Many recurrences are asymptomatic and are only discovered by chance. However, if symptoms reappear (recurring heartburn, feeling of pressure), this should be clarified. Smaller recurrences can initially be treated conservatively again. For larger or symptomatic recurrences, revision surgery is possible – often minimally invasive again, 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?

Quite a bit! Especially with mild heartburn due to hiatal hernia, lifestyle changes can do a lot. Weight loss is the be-all and end-all if you are overweight – even 5–10 kg less can significantly improve reflux.

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

Avoid pressing – treat constipation early (fiber, drink plenty of fluids). Lift heavy objects from your knees, not from your back with breath-holding. For acute complaints, over-the-counter antacids (such as Maaloxan) can provide short-term relief – but for longer-lasting problems, please see a doctor.

Physiotherapy or special breathing exercises can strengthen the diaphragm muscles and thereby provide indirect support. Ultimately, through 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 at 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 strain after surgery, obesity, or congenital connective tissue weakness. The combination of these factors leads to the scar not being able to withstand the internal pressure and a hernia forming.

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

Typical is a soft bulge at the former surgical scar, which protrudes especially when standing or straining (coughing, lifting). In addition, there is often a pulling or pressure sensation in this area. If you notice such a lump on yourself, which may recede when lying down, you should see a doctor. If there is sudden severe pain, redness, or nausea at a scar site, there is suspicion of incarceration – in that case, go to the hospital immediately!

3. is an incisional hernia dangerous?

In itself, an incisional hernia is usually not life-threatening, but it can enlarge and cause increasing discomfort. The greatest danger lies in the incarceration of intestinal parts in the hernia (incarceration). This interrupts the blood supply to the intestine – an acute emergency that must be operated on immediately. If left untreated, incarceration can lead to bowel obstruction or necrosis. Therefore, an incisional hernia should 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 advisable if you have pain or the hernia is getting larger. Only in a few cases (very small, asymptomatic hernia and high surgical risk) can you initially wait. Even then, regular monitoring is important. In the long term, however, incisional hernia surgery is the only curative therapy.

5 How is an incisional hernia operated on?

The standard today is to reinforce the abdominal wall with a synthetic mesh. Often, the operation can be performed minimally invasively (laparoscopically): The surgeon makes several small incisions, inserts a camera, and places the mesh from the inside at the hernia site. For larger incisional hernias or certain situations, an open procedure must be performed. 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 completely pain-free and the abdominal wall is completely relaxed. In some cases, surgery can also be performed under regional anesthesia (spinal anesthesia) or local anesthesia – the latter especially for smaller hernias and open techniques. Our anesthesiologists 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 lasts 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 go home the same day. Overall, you only spend a few hours with us in the OP center, including preparation and recovery phase. This eliminates the need for a longer hospital stay.

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 well controllable. Immediately after the operation, you will receive pain medication so that you feel little. In the days that follow, you will often experience wound pain or muscle soreness in the abdomen, which can be treated well with tablets. Many patients are surprised at how tolerable the pain is – especially after laparoscopic surgery. It is important that you take the prescribed pain medication as needed and take it easy physically.

9 What do I have to consider after the operation?

After an incisional hernia operation, you should maintain physical rest for a few weeks. In particular, avoid heavy lifting (nothing over approx. 5-10 kg in the first 4–6 weeks, depending on the doctor’s instructions). You should also gradually resume sporting activities and only after approval by the doctor. The wounds must be kept clean and dry; you will receive detailed care instructions. In our hernia center VenaZiel, we arrange check-up appointments to monitor healing. We are also available for your questions or any complaints that may arise.

10. when can I go back to work?

This depends on the type of your activity and the size of the hernia. For predominantly sedentary activities, many patients can start working again after 1–2 weeks, provided there are no complications. For physically strenuous occupations or larger hernias, a break of several weeks (up to 4–6 weeks) may be necessary. Your surgeon will give you a recommendation at the final consultation as to when you will be able to work again.

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 companies. In the VenaZiel Hernia Center Berlin, you can be treated as a statutory or private patient. We will explain any co-payments (as is usual with outpatient operations) or formalities to you transparently in advance. So don’t hesitate to postpone an examination or treatment for cost reasons – your health takes precedence, and we are happy to support you with all questions regarding cost clarification.

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

We strive to offer you an appointment as soon as possible. As a rule, you will receive a consultation appointment with our hernia specialists within a few days. If an operation is necessary, it can often be planned promptly – long waiting times like in many large clinics do not arise with us. You can simply make an appointment by phone or online (via our website). We will also find a quick solution for you in the event of acute problems.