Groin hernia surgery

A diagnosed inguinal or femoral hernia should be treated surgically, and the corresponding method depends on the individual. The most modern technology (now: laparoscopic/endoscopic surgery) is not always the best for you.

For young patients, especially young women, laparoscopic/endoscopic surgery with a mesh is not necessarily the best option.

Patients with a medical history of surgery or radiation therapy of the pelvic area as well as patients suffering from a bleeding disorders should not undergo laparoscopic/endoscopic surgery, either.

As you can see, it is crucial to factor in each patient´s individual condition to plan the optimal treatment. Its premise is a comprehensive physical examination and evaluation of medical history and experienced surgeons versed in endoscopic and open surgery as well so that they can find the best solution together with their patients.

Laparoscopic (endoscopic) and “open” surgical procedures require a subtle and gentle surgery technique without being under time pressure that almost does not result in any bleeding at all.

Given a recurrent hernia, it is better to choose a different surgical incision than in previous operations, e.g., a recurrent hernia after laparoscopic surgery is often better treated with an open operation (Lichtenstein technique) and vice versa.

Dr. Lausberg, M.D., who operates patients with groin hernias at Beta Klinik, has been an expert in open and endoscopic surgery techniques for decades.

Open hernia surgery

Both open surgery techniques, the Shouldice procedure and the Lichtenstein procedure, are carried out very precisely with the help of a surgical loupe in order to avoid bleedings and protect the nerves. Decades of experience have proven that this course of action is the best way to avert nerve pain in the groin after surgery.

Shouldice procedure

The Shouldice technique is an open operation, working with an incision in the groin. This outpatient treatment can be undergone under local, regional spinal or general anesthesia. Through the aforementioned incision, the surgeon treats the groin hernia, while protecting the spermatic cord, by reinforcing the transversalis fascia, a thin layer of tendons in the groin, with a double-stitched suture. The inguinal canal, subcutaneous tissue and skin are sutured at the end. The same day, you can stand up, eat and drink. It is advised to refrain from physical challenges and sports activities for 2-3 weeks. Depending on your occupation, you can resume work after 2-3 weeks, too.

Lichtenstein procedure

The Lichtenstein technique is also an open operation to repair groin hernias. This outpatient treatment can be undergone under local, regional spinal or general anesthesia. After an incision in the groin, the direct or indirect hernia is treated, while protecting the spermatic cord. The posterior wall of the inguinal canal is reinforced with a mesh made of polypropylene (after performing an invaginating suture of the transversalis fascia in case of a direct hernia) on top of the layers of muscles and tendons of the abdominal wall. Due to this reinforcement of the inguinal canal, the risk of a new recurring hernia should be minimized. The inguinal canal, subcutaneous tissue and skin are sutured at the end. The same day, you can stand up, eat and drink. It is recommended to avoid physical challenges and sports activities for 2-3 weeks. Subject to your occupation, you can also start working again after 2-3 weeks.

Endoscopic hernia surgery

TAPP technique

When operating groin hernias endoscopically, we favor the so-called TAPP technique, the transabdominal preperitoneal surgery. One advantage is that we can examine the inside of the abdomen by laparoscopy, which is an endoscopic examination with a camera through small incisions. Another advantage is that surgeons with a lot of experience in laparoscopic examinations and surgery are used to working laparoscopically.

TAPP surgery to repair groin hernias requires anesthesia. Normally, a surgeon makes three incision in the abdominal wall (5-10 mm/0.2-0.4 in) to insert a trocar (instrument into which endoscopic instruments are inserted). Carbon dioxide lifts the abdominal wall in order to provide a better view into the abdomen and groin. Bilateral groin hernias can be treated within the same operation, which is a major advantage of endoscopic surgery.

After opening the peritoneum (membrane of the abdominal cavity) just above the hernia, the hernia sac (in case of an indirect hernia) is removed from testicular vessels and the spermatic cord (men) or the round ligament of uterus (women), respectively, and from the inguinal canal. Exposing the abdominal wall completely, a large-pored, partially resorbable mesh is placed and fixed with resorbable clips or special tissue glue to cover and stabilize the gap caused by an inguinal, femoral or obturator hernia (rare hernia of the abdominal wall protruding into a muscular gap of the pelvis). The abdominal wall is sutured laparoscopically afterwards. At the end, trocar incisions are also closed.

You can stand up, drink and eat the day of the surgery. Endoscopic hernia surgery can be an outpatient treatment, but it often makes sense to stay one night at Beta Klinik, undergo a clinical and an ultrasound examination the day after surgery and then go home. As opposed to open hernia surgery, the need for painkillers and the duration of taking painkillers is reduced, but the recurrence rate is also as low as open surgery. Taking a break from sports activities and work after TAPP surgery is necessary for about 1-2 weeks (subject to occupation).