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Inguinal hernias are amongst the most common surgeries performed. Although it is a very common surgery, a higher level of specialization reduces the risk for complications, long-term side effects and recurrences significantly. We offer the full spectrum of minimally invasive and open surgery techniques for the treatment of primary and recurrent inguinal hernias. In most cases we perform these surgeries using the DaVinci Xi robotic surgery system.
Umbilical hernias are very common and are often asymptomatic. Larger hernias or symptomatic umbilical hernias however need a surgical treatment. The ideal treatment of these hernias depends on the size and morphology of the hernia. In most cases a minimally invasive surgery is the preferred approach, in many cases with the use of the daVinci Xi robotic surgery system. Our primary approach ist to keep the operation as minimally invasive as possible.
Incisional hernias can occur after any open or laparoscopic surgery of the abdomen (e.g. colon surgery, C-section). Incisional hernias range from simple, small hernias with minimal abdominal wall defect to large, complex hernias with signs of loss of domain. Depending on the previous surgeries and the anatomical situation an individual approach must be chosen in very patient. We can perform most of these surgeries in a minimally invasive technique.
Robotic TAPP has become our standard approach for the treatment of inguinal hernias. It uses three small incisions of 8mm and provides an overall better image (3d-vision), better precision and improved ergonomics. We observe a tendency to reduced pain and faster recovery compared to conventional laparoscopic approaches. Prof. Clément is amongst the best performing robotic hernia surgeons worldwide, ensuring the best possible outcome for our patients.
In conventional laparoscopic TAPP the technical approach is very similar to the robotic TAPP. The incisions are between 5 and 12mm in length and the surgery is performed in the same way as in the robotic approach. Laparoscopic TAPP can be favored in cases with unclear or complex anatomy (possible adhesions, limitations in trokar position) as it offers more flexibility compared to the robotic approach. It is also readily available in all our partner hospitals.
Open surgery for inguinal hernias still has its place for selected patients. Due to increased postoperative pain an an higher risk for chronic pain it is not a primary procedure in our practice. However it can be chosen in case of recurrence after previous laparoscopic surgery or when a laparoscopic approach is technically challenging or not possible. Our preferred technique is the Lichtenstein procedure with open mesh implantation.
Patients can see a bulging of tissue in their groin area or they can feel pain. The pain can often be localized directly in the groin or in the lower abdomen or the testicals.
In most cases a mesh is used to reinforce the abdominal wall. A closure with sutures only is used in young patients when they are still growing. In all adult patients a mesh is used in all cases and techniques.
In almost all patients the diagnosis can be made wth a simple clinical examination. Further examinations (ultrasound, CT-scan) are needed in special situations only and not as a routine.
As in all surgical procedures we can never achieve 100% perfect results in all patients. However the recurrence rate for inguinal hernias is less than 1% in our patients when a mesh has been used.
Inguinal hernias are rare to cause severe complications. However they present a risk for incarceration with complete bowel obstruction. This can be a life threatening situation needing immediate surgical treatment. Therefore a watchful waiting strategy has to be considered carefully and elective surgical treatment is recommended in most patients.
Femoral hernias are less common than inguinal hernias. They are found more often in women. Typically they present with pain, irradiating to the upper leg and are not easily visible with a typical bulge. A laparoscopic mesh implantation is the preferred treatment approach.
In robotic ventral TAPP the hernia defect is closed and reinforced with a mesh that is placed under the peritoneum. This results in a complete coverage of the mesh with peritoneum, therefore reducing the risk for intestinal adhesions. The mesh can fixed with tissue glue only, resulting in reduced postoperative pain. We chose this approach as our standard whenever possible. In large hernias it might not be possible to achieve enough preperitoneal space to position a large enough mesh. In these cases the placement of an IPOM mesh is always possible in the same procedure.
The laparosopic IPOM technique remains the golden standard in laparoscopic ventral hernia surgery. The hernia is repaired by covering the abdominal wall with a coated mesh. The mesh is fixed to the abdominal wall with absorbable tackers. The size of the mesh can be chosen depending on the hernia size to achieve sufficient coverage in all cases. The coating reduces intestinal adhesions, resulting in a very low complication rate. Postoperative pain can be more severe compared to ventral TAPP due to the fixation with tackers. The pain is limited to a short postoperative phase in most patients.
Open surgery of umbilical hernias has become an exception. Mesh placement is less controlled compared to laparoscopic techniques due to reduced visibility. For the treatment of larger hernias a longer incision is needed, resulting in better visible scars. We choose an open surgery for umbilical hernias in selected cases only.
Most patients with an incisional hernia can benefit from a minimally invasive surgery. In all cases a mesh has to be placed in the abdominal wall to achieve longterm reinforcement and stability. Our preferred approach is the laparoscopic IPOM technique. It offers full flexibility in mesh size and access routes, allowing to treat almost every incisional hernia. In many cases limited or extensive adhesiolysis is needed and can be performed laparoscopically too. The laparoscopic approach reduces the risk for complications significantly (especially wound infections) and results in much faster recovery and shorter hospital stays.
In some patients a laparoscopic approach is not feasible. This can be due to extensive intestinal adhesions or large defects of the abdominal wall after complicated previous surgeries. In these cases an open approach with reconstruction of the abdominal wall a mesh reinforcement in a sublay or IPOM technique must be chosen. For massive hernias we offer specialized techniques to achieve a primary closure of the abdominal wall. This includes the use of Botox or Fasciotens. We pioneered the use of the Fasciotens system in Switzerland.
Parastomal hernias are very common in patients that have a stoma. In most cases no special treatment is needed. However if the parastomal hernia causes problem in the management of the stoma (detachment of the plate etc.), impacts the function (outlet obstruction) or causes pain a surgical treatment is needed. We perform a laparoscopic parastomal hernia repair with the use of a specific IPOM mesh in most cases. With the laparoscopic approach we avoid any incisions near the stoma, therefore reducing the risk of wound infections to an absolute minimum and ensuring a quick recovery of our patients.