When does a hernia need to be operated on?

What is a hernia?

An inguinal hernia occurs when abdominal contents push through a weak point in the abdominal wall. This weak point is in the area of the inguinal canal. This hernial orifice allows tissue (usually fat or intestinal contents) to escape from the abdominal cavity.

Typically, the hernia occurs when there is an increase in pressure in the abdominal cavity, for example when lifting heavy loads, pushing, coughing or sneezing. The most common causes are

• Congenital connective tissue weakness
• Physical overload
• Chronic cough or constipation
• Previous operations or scars

Symptoms of a hernia

The symptoms of a hernia are often non-specific. The typical symptoms include

• Visible or palpable protrusion in the groin area
• Pulling, pressure or burning when coughing, sneezing or carrying
• Pain that can radiate to the testicles or thighs
• Regression of the protrusion when lying down

For women an inguinal hernia often manifests itself more diffusely and is often recognized later.

When is surgery necessary for an inguinal hernia?

The indication for surgery results from several factors:

Immediate surgery required for:

• Incarcerated hernia (incarceration): The contents of the hernia can no longer be pushed back. There is an acute risk of intestinal obstruction.
• Severe pain at rest, nausea, vomiting, stool retention
• Fever, inflammation or signs of peritonitis

Early surgery recommended for:

• Increasing fracture size
• Complaints during exercise
• Physically active patients, athletes or younger patients

Observation possible with:

• Symptom-free, small hernias
• Elderly or multimorbid patients for whom the surgical risk predominates

Risks of an untreated hernia

A hernia does not heal not spontaneously. Without surgical treatment, there is a risk of serious complications:

• Incarceration (incarceration of bowel or fatty tissue): Emergency!
• Strangulation (intestine is cut off from the blood supply): Danger to life!
• Chronic pain
• Increase in size of the fractureDifficult later operation

Modern surgical methods

1. the TAPP method (transabdominal preperitoneal meshplasty)

• • Minimally invasive (keyhole technique)
  • Implantation of a mesh behind the hernial orifice
  • Particularly suitable for bilateral or recurrent hernias
  • Can be performed on an outpatient basis, low complication rate

2nd TEP method (total extraperitoneal meshplasty)

• • Like TAPP, but without opening the abdominal cavity
  • Very gentle, low risk of internal injuries

3. the Lichtenstein method (open surgery)

• • Standard method for unilateral fracture
  • Mesh fixation through groin cut
  • Good long-term results

4. robot-assisted hernia surgery (e.g. with da Vinci®)

• • High-precision technology for complex cases
  • Not yet necessary across the board, but useful for special indications

Healing process & aftercare

• Outpatient surgery usually possible at VenaZiel
• Complete mobilization on the day of surgery
• Incapacity to work usually 1-3 weeks depending on the strain
• Sports activities possible again after 3 weeks
• Very low complication rate with professional treatment

Why VenaZiel Hernia Center Berlin?

• Specialization in minimally invasive hernia surgery
• State-of-the-art technology (TAPP, TEP, open surgery)
• Class 1 outpatient surgery center in a central location (Checkpoint Charlie)
• High patient satisfaction & individual care

FAQ – Frequently asked questions

1. Is a hernia always an emergency? No, but if you are trapped, there is an acute danger to life – then go to hospital immediately!
2. How do I recognize an entrapment? Severe pain, nausea, foul-smelling stools, hard swelling – seek medical help immediately.
3. Can a hernia exist without symptoms? Yes. Many patients only notice a small bulge without pain. Nevertheless, there is a risk of sudden incarceration.
4. Does every hernia need to be operated on? Sooner or later, yes. The only sustainable therapy is surgery.
5. How long does a hernia operation take? Between 30 and 60 minutes, usually performed on an outpatient basis.
6. Is surgery under general anesthesia necessary? As a rule, yes, especially with TAPP or TEP. Open surgery can also be performed under spinal anesthesia.
7. How quickly will I be fit again? Light activities after a few days, sport after approx. 3 weeks.
8. How high is the risk of a relapse (recurrence)? Less than 2 % with modern technology and experienced implementation.
9. What does a hernia operation cost? The costs are usually covered by health insurance. For private patients or self-payers, we will inform you individually.
10. What distinguishes VenaZiel from other centers? Our specialization, experience, state-of-the-art technology and focus on outpatient, gentle procedures with individual aftercare.

Scientific references

1. Simons MP et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13(4):343-403.
2. Bittner R et al. Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias. Surg Endosc. 2019;33:3511-3549.
3. Herniamed Register. Quality assurance in hernia surgery. www.herniamed.de
4. Niebuhr H, Klinge U. Mesh implants in hernia repair. Dtsch Arztebl Int. 2010;107(18):264-271.
5. Baucom RB et al. Patient-centered decision making in inguinal hernia repair. JAMA Surg. 2016;151(7):654-660.
6. Rosen MJ. Minimally invasive hernia repair: a review. Surg Clin North Am. 2013;93(5):1265-1278.
7. Weyhe D et al. Inguinal hernia in men. German Medical Journal. 2020;117(23-24):401-406.
8. International Guidelines for Groin Hernia Management. Hernia. 2018;22(1):1-165.