Hernia Types and Treatments

 

Dr. Clemens Gerstenkorn is an experienced surgeon who has served health care facilities in the United Kingdom, Germany, and Saudi Arabia. Over his career, Clemens Gerstenkorn, M.D., has built expertise in surgery to treat a range of conditions. Among the treatments Dr. Clemens Gerstenkorn provides is surgery for hernias.

A hernia is a section of organ protruding through a weakness in muscle, fascia and tissue. Hernias commonly develop in the upper and lower abdomen, but can also occur in the upper thigh, groin, and belly button. There are four categories of hernia: inguinal, hiatal, umbilical, and incisional.

Occurring in the lower abdomen or groin, inguinal hernias are the most common type. They occur primarily in men and are the result of intestines protruding through the lower abdomen or the inguinal canal. Hiatal hernias, where the stomach protrudes into the diaphragm, is mostly found in patients over 50 or in children who suffer from congenital defects. Umbilical hernias, where intestines press through the abdomen in or near the belly button, occur mostly in babies and young patients. Incisional hernias are the result of intestines protruding through incisions caused by previous surgery.

Hernias typically present as bulges in the groin or abdomen. If a hernia can be flattened - or reduced - by laying down or pressing on it, the condition requires medical attention but should not be considered an emergency. However, if a hernia does not flatten it may be a trapped, or incarcerated, hernia. Incarcerated hernias require immediate medical attention.

Laparoscopic Versus Open Inguinal Hernia Repairs

Clemens Gerstenkorn, MD, serves as a Consultant and surgeon at medical facilities across the world. Over the past five years, Dr. Clemens Gerstenkorn has treated over 200 hernias using both laparoscopic and open techniques. The most common form of hernias are groin, or inguinal, hernias, which occur more commonly in males. Surgical procedures to fix inguinal hernias require patients to undergo local/regional or general anesthetics. 

In open inguinal hernia repair, the surgeon makes an incision in the groin, dissects the hernia and its sack and pushes the content back into the abdominal cavity. The surgeon then repairs the weakness in the fascia and muscle layers, either directly by tightening of the transverse fascia to the inguinal ligament (original version: Bassini technique) or by doubling the fascia transversalis after complete surgical division, without tension (original version: Shouldice technique).The tissue can also be reinforced by using artificial material (mesh component, original technique Lichtenstein). The patient traditionally should stay in hospital for 2 to 3 days, but this period has been shortened more and more especially if the surgery has been done under regional anesthesia, to day surgery or 1 or 2 days hospital stay. 

In laparoscopic inguinal hernia repair, the surgeon makes several small incisions uses either a total extraperitoneal approach or a transperitoneal approach. The preperitoneal space or the abdomen cavity is inflated with carbon dioxide to create a working space. The surgeon then inserts a laparoscope --a lighted surgical camera--through one incision and surgical tools through others and fixes the hernia, always placing mesh over the weakened abdominal wall in these situations and thereby covering the hernia defect. Patients are typically discharged the same day or on day 1 after surgery and recovery usually takes one to two weeks. 
Laparoscopic surgery for inguinal hernia repairs has become more common over the last few years. The main reasons for this are lack of surgical experience and insufficient training for younger surgeons in mesh-free open hernia repairs; as explained above, open repairs require higher surgical skills and experience in excess of at least 200 cases. These simpler techniques however, can be learned quickly and implemented after a few operations. This is also the reason why these techniques are supported in the literature as having low recurrence rates. In reality, the reported recurrence rates are higher in laparoscopic and open mesh repairs as compared to the traditional open inguinal hernia repairs without mesh carried out by a competent experienced surgeon (Bassini, Shouldice). In any aspect, the recurrence rate of an inguinal hernia repair should not exceed 1 or maximum of 2%. The rate of mesh repair is normally not required in excess of 3 or 5% of cases. By avoiding the mesh, the patient is not exposed to artificial material and allergic reactions. If the hernia is incarcerated and a bowel resection is required, then an open operation without mesh is preferred as the risk of infection would otherwise be increased.