HERNIA SURGERY

A tension-free approach to treating abdominal hernia which involves the use of an implant (mesh) placed within the abdominal walls. This technique reduces the rates of abdominal hernia recurrence. In this type of surgery, either one long abdominal incision is made or several shorter ones, if the laparoscopic method is used. The length of the incision depends on the size of the hernia in the case of open surgery, but with laparoscopic technique, there is no such dependence. The patient is hospitalised for up to 2 days, and the operation is performed under general endotracheal anaesthesia, in the surgical setting. The price of the mesh is not included in the price of the procedure.

The surgeries are performed by dr n. med. Andrzej Lehmann.

TAPP stands for a transabdominal pre-peritoneal hernia repair, and TEP for totally extraperitoneal hernia repair. The choice of the treatment method in a specific case is made by the doctor performing the surgery.

After administering general anaesthesia to the patient (putting them under), the doctor inflates the patient’s abdominal cavity with gas and makes 3 small incisions; through these, trocars are inserted, allowing the camera and laparoscopic instruments to be introduced into the abdomen. After gaining transperitoneal or retroperitoneal access to the hernia defect, the hernia contents – such as intraperitoneal fat or intestinal loops – are reduced back into the abdominal cavity. Finally, the wall of the inguinal canal is reinforced with a specially designed 3D mesh that closes off the entrance to the canal. The mesh is attached to the tissues with stitches or special absorbable staples.

The hospital stay is usually 1 day.

At Medicover Hospital, minimally invasive TEP/TAPP inguinal hernia repair is carried out by experienced professionals:

• Prof. UJK, dr hab. n. med. Maciej Kielar
• dr n. med. Marek Witkowski
• dr n. med. Andrzej Lewczuk
• lek. med. Jarosław Wawer
• dr n. med. Jacek Waligóra
• dr n. med. Andrzej Lehmann

IPOM (Intraperitoneal Onlay Mesh) is a transabdominal, intraperitoneal method of hernia repair. In this method, the surgeon places surgical instruments in the abdominal cavity and secures the mesh intraperitoneally, i.e. on the inner surface of the peritoneal abdominal wall. This approach allows for a minimally invasive repair of hernias of the anterior abdominal wall, including postoperative and recurrent epigastric, umbilical and periumbilical hernias, which are the most common.

First, after administering general anaesthesia to the patient (putting them under), a needle is inserted into the abdomen, through which gas (carbon dioxide) is introduced to create space for surgery.

Then, trocars (special sharpened tubes) are inserted into the abdomen, through which a camera and special surgical instruments are introduced. Looking at the TV monitor, the surgeons can see what is happening in the abdominal cavity, and use the tools to operate.

Three trocars are inserted lateral to the hernia defect, typically along the anterior axillary line. After the hernia sac contents are dissected and pushed back to the abdominal cavity, a mesh is introduced. The implant is secured with stitches or staples, covering the hernia defect with a margin of 3–5 cm.

It is important to know that, in some cases, regardless of the surgeon’s experience, a “conversion” may be necessary – that is, switching from a laparoscopic to an open (classic) surgical approach.

The hospital stay is usually 1 day.

At Medicover Hospital, laparoscopic abdominal/umbilical hernia repair is carried out by experienced professionals:

• Prof. UJK, dr hab. n. med. Maciej Kielar
• dr n. med. Marek Witkowski
• dr n. med. Andrzej Lewczuk
• lek. med. Jarosław Wawer
• dr n. med. Jacek Waligóra
• dr n. med. Andrzej Lehmann

The most common method used in inguinal hernia repair is the Lichtenstein method (tension-free mesh technique).

After administering general anaesthesia to the patient (putting them under), the surgeon makes an incision of about 10–15 cm in the groin area. Cutting through the subsequent layers (subcutaneous tissue, fascia), the surgeon reaches the inguinal canal. He identifies and preserves the nerves, blood vessels, and spermatic cord in men or the round ligament of the uterus in women. He then locates the hernia sac and reduces its contents back to the abdominal cavity. Next, he performs inguinal canal repair, reinforcing it with a mesh. The mesh is then covered with the aponeuroses, muscles, and fascia of the abdominal wall, followed by the skin.

If there is a risk of bleeding, a drain is placed in the wound (a tube with holes to drain liquid from the wound). The drain is usually removed the next day.

Finally, the subcutaneous tissue and the skin are closed separately with absorbable sutures. The wound is washed, wiped dry, and a dressing is applied. In male patients, the surgeon gently pulls on the testicle on the operated side after the procedure to ensure it moves properly. This is a way to check whether the spermatic cord has not been sutured too tightly.

The hospital stay is usually 1 day.

At Medicover Hospital, open inguinal hernia repair is carried out by experienced professionals:

• Prof. UJK, dr hab. n. med. Maciej Kielar
• dr n. med. Marek Witkowski
• dr n. med. Andrzej Lewczuk
• lek. med. Jarosław Wawer
• dr n. med. Jacek Waligóra
• dr n. med. Andrzej Lehmann

Modern methods of treating abdominal hernia are tension-free, meaning that repair is performed without stitching living tissues under tension. Instead, a synthetic implant (mesh) is placed within the abdominal walls and secured with sutures to the surrounding tissues. This technique has reduced the rates of abdominal hernia recurrence.

The above approach involves placing a special mesh through a small 1–2 cm incision, then unfolding it inside the abdominal cavity to the appropriate size (6–8 cm), without the need to enlarge the skin incision. The mesh can be made of non-absorbable material (polypropylene), or it can be partially absorbable. The choice of mesh type and size will be made by the surgeon depending on the size of the hernia defect.

The hospital stay is usually 1 day.

At Medicover Hospital, open umbilical hernia repair is carried out by experienced professionals:

• Prof. UJK, dr hab. n. med. Maciej Kielar
• dr n. med. Marek Witkowski
• dr n. med. Andrzej Lewczuk
• lek. med. Jarosław Wawer
• dr n. med. Jacek Waligóra
• dr n. med. Andrzej Lehmann

Open abdominal hernia repair involves surgical closure of the hernia defect and strengthening of the abdominal wall using a special synthetic mesh placed under the muscles and abdominal fascia (sub-lay method). The patient is hospitalised for up to 2 days, and the procedure is performed under general endotracheal anaesthesia, in the surgical setting. The price of the mesh is not included in the price of the procedure.

The surgery is performed by dr n. med. Andrzej Lehmann.

In our Hospital, we use the da Vinci Surgical System for inguinal, abdominal and parastomal hernia operations. Hernia repair with the da Vinci System is associated with a number of benefits for the patient:

- The postoperative hospitalisation is extremely short, usually 1-2 days, even in cases of large hernia.

- The postoperative wounds are smaller, hence the risk of infection is reduced.

- Pain is also reduced and there is a lower risk of recurrence than with traditional methods of surgery.

At Medicover Hospital, inguinal, abdominal and parastomal hernia repairs with the da Vinci System are carried out by an experienced surgeon,

dr n. med. Jerzy Draus. You can read more about the operator and the procedures carried out with the da Vinci System here.