Inguinal hernia

Symptoms of an inguinal hernia

• Do you keep having problems in the area of ​​your groin with swelling, aching pain or a feeling of pressure?
• Does an unnatural swelling occur there, suddenly without any action or perhaps due to an increase in pressure in the abdomen, for example when coughing, lifting heavy objects or having a bowel movement?
• The swelling then disappears by itself, for example when you lie down?
• Do you occasionally experience nausea and vomiting or even dizziness?
• The bulge might reach down into the labia or the testicles?
• Is it possible that pain occurs again and again after exercising, possibly without swelling, with a pulling sensation or a dull pressure in the testicles or thighs?
• The groin pain sometimes occurs at rest and sometimes with almost every movement?
• The swelling may only be noticeable when sitting, but not when standing?
• Or have you already been diagnosed with a hernia or a “soft groin” by another doctor?

Registration at the doctor’s office

If you suffer from one or more of these conditions, professional assessment from an experienced surgeon is always recommended.
You can easily, quickly and confidentially arrange an appointment in our doctor’s office.
As a surgical doctor’s officewith panel doctors, we can offer our expertise to both statutory and privately insured persons.

• by phone
• directly online in the appointment calendar on our website or
• by email.

initial consultation

At the first appointment, it is important that you can describe your symptoms in detail and calmly, how they affect you in everyday life, how long the problems have been occurring, how they could be influenced and how the entire course of time has developed.

It is important that sufficient time is devoted to the complaints at this stage, as even seemingly unimportant details can be crucial clues.
Targeted questions by the experienced surgeon often give a good first indication of the cause of the symptoms.

Inguinal hernias are congenital, but can also be acquired, especially if the pressure in the abdomen is frequently or particularly severely increased, for example due to heavy work, pregnancy, chronic coughing (smokers), ascites, frequent vomiting or frequent constipation.

But the initial consultation is more than just listing complaints by type, severity, time of occurrence and ways to influence them. The initial consultation must always provide space for a professional acquaintance with the person who trustingly goes into treatment.

Different people may objectively have the same complaints, but they are perceived individually, which is unbearable for some, but doesn’t bother the other at all and vice versa, and so the assessment by the surgeon must also take this fact into account and that is only possible if the initial consultation is not reduced exclusively to the objective complaints, but focuses on the person as an individual with their own assessment of their physical problem.

Physical examination

In addition to describing the history of the symptoms, the physical examination is one of the main pillars for finding a diagnosis. It is of course important to you that the physical examination is also in the hands of a surgeon with many years of clinical, instrumental and surgical experience in order to avoid misinterpretations. After all, it should be routine and discreet and quickly lead to a reliable result.

The inguinal hernia reveals itself clinically by palpating typical changes in the abdomen, groin and possibly also the scrotum. Listening can also be important. The sonographic interpretation of the groin requires a lot of experience, but can be decisive for the diagnosis if the clinical findings are not clear. In our doctor’s office we offer you the ideal combination of experienced examiners and modern technical equipment.

In very rare cases, an MRI is required to confirm the diagnosis.

Diagnosis and explanation

The diagnosis results from the history, the physical examination and the technical examination (sonography).
I would then like to explain to you exactly what it means to have an inguinal hernia (hernia).

• What exactly are the anatomical changes in your body?
• How and why did these develop?
• How severe is this illness?
• Are organs also affected, for example the small intestine?
• Will the changes change in the future?
• What effects can be expected on other areas of life?
• Are further investigations necessary?
• Are the changes harmless or dangerous?

Ultimately, you should be able to recognize which anatomical change causes your symptoms in which way mechanically and how your change should be evaluated individually in comparison to most other patients in the eyes of an experienced surgeon.

Your referring family doctor automatically receives a detailed report of findings and recommendations from us, so that a professional flow of information is guaranteed.

Treatment options

There are several ways to treat hernias. The purely conservative, i.e. non-surgical and observational treatment is possible in individual, rare cases. In most cases, however, the diagnosis of an inguinal hernia already means that an operation is necessary, since these hernias do not recede on their own and there is always a risk of entrapment of abdominal contents.

A trapped hernia is an emergency and must be recognized quickly and operated on immediately in order to avoid a serious course of the disease if parts of the intestines such as the peritoneum, fat or small intestine are trapped and die.

If no other serious illnesses stand in the way of general anesthesia, a fracture should therefore be operated on. And even if general anesthesia is not possible due to severe general illnesses, it is still possible to operate under local anesthesia so that these seriously ill patients are relieved of their symptoms and are not exposed to the risk of entrapment.

As long as there is no entrapment of intestines, the timing can be planned so that the procedure takes place at the most convenient time for your family and work, our doctor’s officewill give you the maximum support for the greatest flexibility in this regard. In principle, there is the option of operating laparoscopically or conventionally.

Laparoscopic surgery

Laparoscopic means that the hernia is closed from the inside with a mesh via small incisions on the navel and on the abdominal wall in the lower abdomen. This technique is sometimes also referred to as the keyhole technique or as „minimally invasive“ because a rod camera and long surgical instruments are used performs the operation through the small access openings in the wide abdomen behind.

Conventional surgery

Conventional means that the hernial sac is exposed from the outside via a skin incision slightly above the inguinal ligament and removed or relocated back into the abdomen. The abdominal wall is then reinforced, either by the most proven of the numerous existing methods, in which anatomically present ligaments and tendons of the abdominal wall are gathered, sewn and doubled, or by inserting and suturing a mesh in front of the abdominal wall, which the intestines will be attached to in the future intended place in the abdomen.

Which method is right for you?

All surgical procedures used in our doctor’s officehave been scientifically well researched and have proven themselves hundreds of thousands of times in terms of tolerability during and after the operation as well as the success of the treatment. Which of the treatment options is the right one for you depends on many different factors.

Which method is recommended for you depends, for example, on which anatomical changes are present, whether there are concomitant diseases, which anesthesia is possible, how old you are or whether the fracture has already been operated on.

Of course, just as important for whether a procedure is more suitable or not are the circumstances related to you as a person, your genetic predisposition, your living conditions, your level of activity, your hobbies and your job.

It is particularly important to us that you work with us to find the most suitable procedure for you from the various good options for fracture treatment. We succeed in doing this by allowing your personal circumstances to flow in and allowing us to use our professional experience.

We take as much time as it takes, because this not only corresponds to modern interaction between doctor and patient, but also primarily determines the success of the therapy.

Planning and preparation of the surgery

Operating with minimal bleeding is part of reducing surgical risks. One of the prerequisites for this is good blood clotting. Many patients take blood-thinning medications, including aspirin (ASA), Marcumar, Xarelto, Plavix, and others. If possible, these drugs must be discontinued in good time before the procedure. Whether this is possible is sometimes only a matter of consultation with the doctor who prescribed the medication, such as your general practitioner, angiologist, cardiologist or neurologist.

In advance, the family doctor should prepare a current laboratory with blood count, liver values, inflammation values ​​and coagulation.
In the case of certain previous illnesses, clarifying examinations such as an X-ray of the lungs or functional tests of the lungs and heart are also important in order to be able to assess the risk of anesthesia.

Please bring all the papers and reports you have about yourself with you, that is

• medical letters
• findings reports
• allergy pass
• X-ray passport
• blood group card
• List of medications, especially insulin regimens for diabetics and anti-Parkinson medication for M.Parkinson.

The preparation for the operation includes an informative discussion about the type and scope of the planned operation. It also discusses the possible complications and risks. This briefing gives you the opportunity to ask any questions you have about the surgery.

• Which procedure is used in your case and for what reasons?
• What exactly is done during this operation?
• What type of anesthetic is used for the operation?
• How long does this operation take?
• What are the risks of this operation?
• How long may you need to stay in the hospital?
• What scars will be left from the surgery?
• What complaints can be expected in the future?
• How likely is it that the hernia will come back?

The interview is based on a standardized information sheet, which also serves as a legally relevant document.

Dealing with uncertainty, anxiety and nervousness

Of course, the informational discussion must also take into account aspects that go beyond the factual facts. Many people experience anxiety when they think about having an operation. We know how regularly this fact is simply ignored in modern medicine, despite the fact that it plays such an important role. Especially if you have never had an operation before, you may feel uncertain and nervous before the procedure.

By addressing and discussing these concerns in a targeted manner, a prepared and confident mind is ultimately created in addition to the extensive factual information. You can then go into the surgical treatment with complete confidence. For us, you as a person are the focus of our activities and our actions are geared towards ensuring that you also feel optimally cared for emotionally.

Inpatient surgery

Inpatient surgery is necessary for patients who require close professional care after the operation, whether due to pre-existing or anticipated causes, e.g. severe illness, increased risk of complications, severe pain due to extensive surgery or more complex drug therapy (intravenous, subcutaneous, special schemes).

If an inpatient operation is discussed with you, it is advisable to prepare your stay using the following checklist.

• Toothbrush, toothpaste, dentures
• Shampoo, soap, deodorant, towels, washcloth, comb, brush
• feminine hygiene items
• Underwear, socks, bathrobe, loose clothing without an elastic waistband, pajamas/nightgown, sturdy slippers.

avoid

• to take large sums of money, valuables and jewelery with you, as the clinic is not liable for them.
• Painting your fingernails as this can prevent blood oxygen readings.

It is important that you remain sober on the day of the operation until the operation, as anesthesia and ventilation with a full stomach poses a great risk to the patient. The anesthesiologists refuse to carry out the anesthesia if you are not sober, especially in the case of interventions whose timing can be planned and which do not constitute an emergency.

Sober means:

• please no solid food after 10 p.m. the day before
• please no drinks (water, coffee, juices, etc.) after getting up
• no smoking please
• please no chewing gum
• please take the permitted medication (not discontinued for the operation) with the smallest possible amount of water (non-carbonated).

Please come to the clinic on the agreed date and report to the gate. After being greeted, you will be escorted to the ward and introduced to the friendly staff who will look after you during your stay.
You will then receive precise information about which preparations have to be carried out before the operation and in which order.

Performing the surgery

Depending on need and possibility, the surgical interventions are carried out on an outpatient or inpatient basis in modern operating theaters with experienced and highly specialized staff.
The operation as a decisive focus in the treatment process is carried out exclusively by myself.
This is the only way to ensure that all factors that were important in the examination, in the preliminary discussions and in the informational discussion are known to the surgeon first-hand and can be taken into account during the procedure.
Conversely, an optimal individual follow-up treatment can only take place if the circumstances during the operation are known as precisely as possible.

A surgical procedure is always teamwork, the anaesthetist, anesthesia nurse, instrument nurse, operating room jumper and operating room assistant work closely with the surgeon. In this way, everyone contributes to a patient-friendly, safe, uncomplicated and perfect operation.
It is all the more important for my patients and me that the procedures take place in an ideal environment in this respect.

Outpatient operations are carried out in the Isar-AOP.
This ensures that after the procedure you will receive friendly and professional care in equal measure.

Post-treatment

As soon as you wake up after the procedure, you will be pain-free in the surgical area. This is due to the fact that you will have had a local anesthetic injected into the operated area, independently of the operation performed. Its effect lasts beyond the intervention. Involuntary reactions of the body, which otherwise occur with pain, do not occur and also contribute to your well-being.
Over the course of the next few days, you will be given mild to moderate painkillers, which you should take as needed.
Lying in bed is not necessary; instead, exercise is even recommended to avoid thrombosis.
Physical rest for about 3 weeks is advisable, during this time there is usually also an inability to work. At least during this time, you should avoid creating increased pressure in the abdomen. This could lead to damage to the abdominal wall in the surgical area that has not yet grown together.
For example, do not lift any heavy objects during this time, avoid strenuous sports and, if necessary, regulate your bowel movements with softeners.

A suture is usually not necessary because we use absorbable sutures to close the skin. If, exceptionally, we have to use non-resorbable thread material, we remove these threads on the 12th day after the operation.
With a waterproof plaster on the wound, you can take a shower at any time after the operation; it is better to wait around 14 days after the operation for a full bath and sauna sessions until the wound has healed.

In any case, you will receive a detailed note on which all recommendations for behavior and information on follow-up treatment can be read at any time.

In acute emergencies, you can of course contact us personally at any time by telephone.

Controll visit to the doctor’s office

After discharge and in the case of outpatient operations, a check-up visit to the surgical doctor’s office follows about a week after the operation.
We then check the surgical wound and the clinical and sonographic findings after the operation.
All appointments will of course be given to you in writing as a reminder.

After completion of the treatment, your family doctor will receive a detailed report on the entire process, including the operation performed, the recommended follow-up treatment and medication.