Abdominal wall hernias in general (hernias)

A hernia is a pathological gap in the abdominal wall through which the peritoneum and possibly also organs of the abdominal cavity protrude outwards. The most common localisation of an abdominal wall hernia is the groin. In addition to hernias that develop practically on their own without any previous changes to the abdominal wall, so-called incisional hernias can develop after wounds in the area of the abdominal wall (e.g. surgical scars). Incisional hernias occur because the scar tissue has far less stability than the normal healthy abdominal wall. Factors known to favour the development of a hernia include obesity, protein deficiency and illnesses associated with severe coughing attacks. Every hernia should be treated or repaired surgically due to the risks associated with it. It is important to determine which structures and organs are located in the so-called hernia sac and whether the contents of the hernia sac are trapped or not. If it is trapped, surgery must be performed immediately.

Inguinal hernia (inguinal hernia)

An inguinal hernia can be congenital, especially in premature babies, or can develop in the course of life as a result of external factors (constipation, lung disease, ascites) or connective tissue weakness. Typically, there is swelling in the groin area, especially during physical exertion, with or without pain. By applying pressure to the hernia, it can sometimes be repositioned (reduction). If a doctor is unable to reposition the hernia, this is referred to as an incarceration. In this case, a surgical presentation should be made immediately. The risk of incarceration is permanent damage to the contents of the hernia sac. In general, every hernia should be operated on. Non-surgical treatment, e.g. with a hernia band, is no longer recommended today. The operation can be performed under different types of anaesthesia: Inhalation anaesthesia, spinal anaesthesia or local anaesthesia. Surgical procedures are available with or without the insertion of plastic mesh. A classic open procedure (Shouldice technique) can be used or a minimally invasive surgical procedure with mesh insertion (keyhole surgery). After treatment of an inguinal hernia, a period of physical rest of varying lengths is recommended, which is 1 to 2 weeks for a minimally invasive surgical procedure and approx. 12 weeks for an open surgical procedure.

Incisional hernia (incisional hernia)

A hernia can form in the area of surgical scars (see above for definition). This can be caused by a weakness of the connective tissue or medication (cortisone), inflammation or increased intra-abdominal pressure. In addition to pain, the protrusion can be observed in the area of the scar, especially when coughing or standing. The diagnosis is confirmed during the physical examination, which can be supplemented by ultrasound or other surrounding examinations. Immediate surgery should be performed if the contents of the hernia are trapped (incarceration). An incisional hernia should always be treated surgically, as it does not regress and, depending on its size and the contents of the hernia, there are considerable risks of complications(abdominal wall hernia, inguinal hernia). As a patient, you can make a lasting contribution to the success of the operation by significantly reducing your weight before the operation if you are overweight. The so-called Mayo fascial duplication or the insertion of special meshes are available as surgical procedures. Our patients are informed individually about the extent to which they should take it easy physically.

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Appendicitis (inflammation of the appendix)

Appendicitis is actually an inflammation of the vermiform appendix, which is located at the beginning of the large intestine (cecum) in the right lower abdomen. The vermiform appendix forms part of the human immune defence system, but is dispensable. A distinction is made between acute appendicitis and recurrent appendicitis or irritation of the appendix. Typical symptoms are tenderness in the right lower abdomen, signs of inflammation with fever, vomiting and loss of appetite. However, appendicitis can also cause rather atypical symptoms that suggest a different clinical picture.

The diagnosis is made by the doctor on the basis of the symptoms and physical examination. In addition, laboratory tests (white blood cells, C-reactive protein) and an ultrasound examination of the abdomen and, in individual cases, a consultation with a gynaecologist are common.

The appendix can be removed via a skin incision in the right lower abdomen or using a minimally invasive (keyhole surgery) surgical method. Which technique is used is discussed individually with our patients depending on the findings. The main complications are also explained during this discussion. Our patients are usually allowed to drink tea 6 - 8 hours after the operation. In most cases, the skin is closed with a self-dissolving suture that does not need to be removed. If the appendix has perforated (perforated appendicitis), it depends on the severity of the peritonitis whether drainage tubes need to be inserted and whether the hospital stay will be extended due to a longer healing period.

Gallbladder and bile ducts

The gallbladder is an approx. 2 x 8 cm long storage organ that lies on the underside of the liver and temporarily stores the bile produced in the liver in order to release it into the duodenum in response to food and hormone stimuli. This organ becomes diseased on the one hand through the formation of gallstones and on the other (much more rarely) through the formation of malignant tumours. Gallstones can vary greatly in number and shape. They become pathological when they cause symptoms (pain in the upper abdomen, colic, vomiting, food intolerance). An operation is then indicated. The removal of the gallbladder is generally carried out using minimally invasive techniques(keyhole surgery).

In special cases, open gallbladder removal via a right-sided incision below the costal arch is used. In principle, both the gallbladder duct and the gallbladder artery are cut off.

The gallbladder is then removed from the gallbladder bed of the liver and sent for histological examination. A significant change in diet is not necessary, except in special disease constellations. If a gallstone is trapped in the common bile duct (choledocholithiasis), the stone can first be removed endoscopically (using ERCP). A few days later, the gallbladder is surgically removed.

Malignant tumours of the bile ducts are indicated by the sudden appearance of jaundice (icterus). Surgical treatment depends on whether the main bile duct near the pancreas is affected (pp-Whipple surgical procedure - see pancreas) or the bile duct near the hepatic portal is affected (so-called Klatskin tumour). In this case, the main bile duct is surgically removed right into the hepatic portal. The bile is then drained via a sutured loop of small intestine.

The clinic offers special nutritional counselling and symptom-oriented aftercare(nutritional counselling).

Endoscopy and proctology:

Appointments available daily from 08:00 - 12:30 - Telephone - 0731-50044632

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