Hernia surgeries (inguinal hernia, umbilical hernia, abdominal wall hernia)

A hernia is a disease, which develops as a consequence of the congenital or acquired loss (defect) of the abdominal wall. This means that the organ in the abdominal cavity gets outside of it through the hernia opening by pushing the peritoneum (hernia sac) in front of it. There are abdominal, inguinal, femoral, and rare hernias.

Umbilical and epigastric (close to the stomach) hernias are most commonly referred to as abdominal wall hernias. An abdominal wall hernia may also develop in the scars of abdominal surgeries due to the scarring and weakening of the abdominal wall. These hernias are called incisional hernias.

The inguinal hernia, which is bulging through the inguinal canal develops in a natural opening, the inguinal canal. In men, the testicles descend in the inguinal canal, and the spermatic cord along with the artery and the vein, which provide supply to the testicles, are also located here. If the inguinal hernia gets bigger, a testicular hernia, the so called inguinoscrotal hernia develop. In women, the round ligament of the uterus runs in the inguinal canal.  A femoral hernia is rare, but it occurs more commonly in women. It develops in the canal of the vascular structures which run to the thigh, below the inguinal ligament.

The description of the surgical treatment

The bulging hernia sac and its content is put back to the abdominal wall through the hernia opening, which is then constricted or closed. The intervention can be performed with a laparoscope or with open surgery. The optimal surgical solution is selected during the consultation of the patient and the surgeon, following the review of the healthcare documentation, and a thorough physical examination, taking all national and international professional guidelines into consideration.

What kind of solutions are available?

Abdominal wall hernia, open technique:

• Spitzy’s surgery in case of an umbilical hernia: The abdominal wall is closed and strengthened with a tissue friendly plastic mesh from a curved incision around the belly button.
• Other abdominal wall hernias: The abdominal wall is closed and strengthened with a tissue friendly plastic mesh.
• Rectus diastasis surgery means that the straight abdominal muscle is pulled together with a row of sutures, following which a mesh can be implanted, if necessary.

Abdominal wall hernia, laparoscopic technique:

• IPOM: Pulling the hernia sac back from the abdominal wall and closing the hernia opening and implanting a tissue friendly plastic mesh, if necessary.

Inguinal hernia, open technique:

• Lichtenstein surgery: conventional open technique. After making an oblique incision of 5 10 cm, the hernia sac is prepared and closed. The content of the hernia sac is reviewed in every case. Once the hernia opening is constricted and the abdominal wall is strengthened, it is necessary to implant a plastic mesh, which is secured by sutures. In some exceptional cases, the placement of the mesh can be dismissed (e.g., in case of young women), this is called the Shouldice procedure. If necessary, the layer underneath the skin is closed with a row of absorbable, and the skin is closed with a row of non absorbable sutures, in addition to leaving a suction drain behind.

Inguinal hernia, laparoscopic technique:

• TEP (total extraperitoneal repair): in the belly button, a probe of 10 mm (metal or plastic tube through which camera and devices can be inserted), and over the pubic bone and a few centimeters further up in the midline, probes of 5 mm are inserted into the tendinous diaphragm of the straight abdominal muscle. The hernia opening is pulled back and the mesh is implanted in a space that is created with carbon dioxide between the layers of the abdominal wall (Retzius space). The abdominal cavity is not penetrated with this technique. In this case, it is not necessary to secure the mesh, because it is held inside by the adjacent layers of the abdominal wall. 
• TAPP (transabdominal preperitoneal repair): a probe of 10 mm (metal or plastic tube through which camera and devices can be inserted) is inserted in the belly button, and a probe of 5 mm is inserted in the abdominal wall. After the abdominal cavity is filled with carbon dioxide, the inflammation of the peritoneum is opened, the hernia opening is pulled back, then the mesh is implanted and secured with staples.

How can I avail of this service?

It is also true for scheduled surgeries that patient’s safety is first, so to achieve that, the patient should be in the most optimal state when undergoing surgery. The point of the investigation preceding the surgery is that we get a picture about the known and the potentially unknown diseases of our patient. The usual steps of the examinations are the laboratory tests, ECG, and imaging studies, which are complemented by further examinations for the patient’s comorbidities, or professional opinions from specialists may be requested regarding the surgical aspect of the concurrent comorbidities, if necessary.

Potential inflammations, which are not related to the surgery have special importance e.g., purulent tonsillitis, urinary tract infections, gynecological inflammations. Their treatment before surgery (preoperative treatment) is important because they may be the focus of an infection from where pathogens can get to the surgical site by blood stream and may cause wound suppuration during the days after the surgery, compromising the success of the surgery.

We provide the preoperative examinations in our health center of Királyhágó street based on appointments booked in advance:

• Laboratory tests, sedimentation, complete blood count, complete urine, blood sugar, sodium, potassium, carbamide, creatinine, total bilirubin, total protein, GGT, GOT, GPT, CRP, INR, blood typing + Rh-antibody screening, nasal swab for MRSA (we also accept an external finding not older than 1 month)
• (Bidirectional) chest X ray – we also accept an external finding not older than 5 months.
• Abdominal ultrasound scan
• ECG at rest – we also accept an external finding not older than 1 month.
• Consultation with a gastroenterologist and endoscopy, if necessary.
• Medical examination by an anesthesiologist – we only accept the opinions of the anesthesiologists of Buda Health Center.