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Treating hernias - information for patients & relatives

Hernia operations are some of the most common procedures in general and visceral surgery.

What are hernias?

Hernias occur when the peritoneum (abdominal wall) moves through a gap in the muscle into the abdominal wall or diaphragm. Parts of the abdominal organs (e.g. the intestine or stomach) can also be pushed into the so-called hernial sac and become trapped. Hernias do not get better on their own and may be life-threatening in certain circumstances (if the intestine is trapped and dies off). For this reason, surgical treatment is inevitable after a certain point. 

There are several different types of hernia: 

  • Inguinal hernia: With an inguinal hernia, the peritoneum pushes downwards through a weak spot in the area of the inguinal canal, above the inguinal ligament. Inguinal hernias account for approximately 80% of all hernias, making it the most common type. It mostly affects men. 
  • Umbilical hernia: An umbilical hernia occurs at a weak spot of the abdominal wall in the area of the belly button.
  • Incisional hernia: Incisional hernias occur in the area of surgical scars in the abdominal wall. 
  • Parastomal hernia: If the incisional hernia forms at a stoma (artificial bowel outlet) it is called a parastomal hernia.
  • Epigastric hernia (abdominal wall hernia, abdominal hernia): If the hernia occurs at a weak spot of the abdominal wall between the belly button and the breastbone it is called an epigastric hernia. 
  • Diaphragmatic hernias (hiatus hernia): With a diaphragmatic hernia, the peritoneum moves from the abdomen into the chest cavity. This is not a muscular hernia in the literal sense because it is caused by the enlargement of the opening in the diaphragm through which the oesophagus reaches the stomach. 
  • Femoral hernia: In the case of a femoral hernia, the hernial sac forms below the inguinal ligament (usually on the inside of the thigh). Femoral hernias occur very often in older women. 

Surgical treatment

The types of procedures are divided into open hernia surgery and minimally invasive (laparoscopic) hernia surgery. Moreover, there are essentially two methods of hernia repair: closure of the hernia gap with a suture and closure using a synthetic mesh implant. The suturing technique is primarily used for small hernias or in children and adolescents. The mesh implant is used much more often to reinforce the closed hernia site and generally leads to fewer recurrence of the hernia.

The appropriate technique is always selected on a case-by-case basis. It depends on the patient’s general condition and the type and size of the hernia. Therefore, a comprehensive diagnostics by an experienced physician – ideally in a certified hernia centre.  

For treatment with mesh implants, in particular, it is essential that the surgeon is experienced in this field. 

Treatment with titanised mesh implants

pfmmedical mesh implants are coated with titanium, which provides many advantages for the patient during treatment:

  • Better tolerance: The titanisation means that fewer seromas (collection of fluid in the wound area) occur postoperatively.1 
  • Less postoperative pain.2
  • Quicker recovery: After the implantation of titanised mesh implants, patients can return to symptom-free everyday life earlier.2,3 
  • Decreased foreign body sensation The titanisation minimises the inflammatory response, which in turn means reduced scarring and mesh shrinkage.4,5,6 Patients experience the mesh less as a foreign body.

You can find out more about titanisation and the manufacture of these meshes here.

  1. Horstmann R., Hellwig M., Classen C., Röttgermann S., Palmes D., Impact of polypropylene amount on functional outcome and quality of life after inguinal hernia repair by the TAPP procedure using pure, mixed, and titanium-coated meshes. World J Surg., 2006. 30(9): p. 1742-1749.
  2. Moreno-Egea A., Carrillo-Alcaraz A., Soria-Aledo V., Randomized clinical trial of laparoscopic hernia repair comparing titanium-coated lightweight mesh and medium-weight composite mesh. Surg Endosc, 2013. 27(1): p. 231-239.
  3. Koch A., Bringman S., Myrelid P., Smeds S., Kald A., Randomized clinical trial of groin hernia repair with titanium-coated lightweight mesh compared with standard polypropylene mesh. Br. J. Surg., 2008. 95(10): p. 1226-1231.
  4. Scheidbach H., Tannapfel A., Schmidt U., Lippert H., Köckerling F., Influence of titanium coating on the biocompatibility of a heavyweight polypropylene mesh. An animal experimental model. Eur Surg. Res., 2004. 36(5): p. 313-317.
  5. Zhu L. M., Schuster P., Klinge U., Mesh implants: An overview of crucial mesh parameters.World J Gastrointest Surg,2015. 7(10): p. 226-236.
  6. Wood A. J., Cozad M. J., Grant D. A., Ostdiek A. M., Bachman S. L., Grant S. A., Materials characterization and histological analysis of explanted polypropylene, PTFE, and PET hernia meshes from an individual patient. J Mater Sci Mater Med, 2013. 24(4): p. 1113-1122

 

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