Inguinal hernia operation expert Reinpold Niebuhr
Your Specialized Center for Hernia Treatment

Inguinal hernia surgery: International experts from Hamburg

Inguinal hernia – what is it? How to recognize it? Where can I find help in Germany? How does the surgery proceed? Here you will find answers to the most frequently asked questions on the subject.

Good to know in advance: An inguinal hernia can only be cured by surgery. If left untreated, there is always a risk of incarceration of the hernia. At the Hamburg Hernia Center, we have various surgical procedures at our disposal. We will decide together which surgery is right for you.

Inguinal hernia surgery in Germany:
3 reasons for our Hernia Center

  • At the Hamburg Hernia Center, we guarantee treatment by proven specialists.
  • Together, our team of physicians looks back on a worldwide unique experience of more than 30,000 hernia operations.
  • At our locations throughout Hamburg, you are in expert hands from the preliminary examination to surgery and aftercare.

Beforehand in a nutshell

What is an inguinal hernia?
An inguinal hernia describes a gap above the inguinal ligament. It is the most common form of abdominal wall hernia, affecting men in particular – always based on a weakness of the connective tissue and additionally favored by increased pressure in the abdominal cavity.

How do you know you have a hernia?
An inguinal hernia is primarily noticeable by a soft bulge in the groin area and, in some cases, by sudden onset of pain.

How soon does a hernia need to be operated on?
Since an untreated hernia can become increasingly larger and there is always the risk of (life-)threatening incarceration, rapid surgery is advisable after a confirmed diagnosis.

Inguinal hernia - what is it?

Inguinal hernias are a particularly common form of hernias. It is a gap over the inguinal ligament. In men, this is the place where the spermatic cord, nerves and blood vessels pass through the abdominal wall. Thus, anatomically, inguinal hernias are particularly common in men. A special form in male patients: If the hernia extends into the scrotum, it is called a testicular hernia.

Experts say scrotal hernia.

Inguinal hernias can also affect women. However, femoral hernias are much more common in female patients.

Inguinal hernia cause: connective tissue weakness

Inguinal hernias are almost never caused by an accident – such as the infamous “lifting”. However, it is often the trigger. One thing is certain: Inguinal and other abdominal wall hernias always involve a weakness of the connective tissue. The connective tissue consists of collagen fibers. These are often less well interconnected in hernia patients, causing weak points in the abdominal wall.

In general, hernias occur where the abdominal wall is weak. High pressure inside the abdomen then leads to a hernia.

Risk factors

The actual cause of the inguinal hernia is therefore a weakness of the connective tissue. Increased pressure in the abdomen due to the following risk factors favor a hernia.

  • Cough/lung disease (chronic)
  • Overload due to weight lifting and/or heavy labor
  • Constipation
  • Severe overweight
  • Cortisone intake (permanent)
  • Cytostatic therapy
  • Abdominal fluid, including cirrhosis of the liver, protein deficiency, peritoneal dialysis
  • Cortisone duration therapy
  • Malnutrition
  • Disturbed protein balance
  • Tumors in advanced stage

Inguinal hernia: symptoms

How can you recognize an inguinal hernia? Number 1 of the inguinal hernia symptoms: a soft bulge on the abdomen or in the groin region. For example, when you cough, you can see the hernia. Less common symptoms include sudden pain in the groin area.

Even if the symptoms seem clear: A doctor is the best person to recognize a hernia. If you observe typical symptoms of an inguinal hernia, please contact your family doctor or another specialist. The treatment or surgery should then take place in a specialized hernia center like ours in Hamburg.

Inguinal hernia: incarceration is an emergency

A bulge on the abdomen, pain now and then: initial hernia symptoms are tolerable for most sufferers. Thus, many patients see the hernia primarily as a visual flaw. But an inguinal hernia should not be underestimated. The danger: intestines or other organs can slip through the tear in the abdominal wall. In the worst case, the hernia leads to an incarceration, an intestinal obstruction, among other things, may follow. The inguinal hernia can thus become a (life-)threatening emergency!

Incarcerated inguinal hernia: symptoms

How can you recognize an incarcerated hernia? An incarcerated hernia usually causes severe pain. The protrusion remains, does not recede even when lying down. Even a doctor cannot push back the hernial sac. The incarcerated hernia is often accompanied by abdominal pain and nausea.

We at the Hamburg Hernia Center – a network of specialized practices and clinics – therefore have one guiding principle:

The sun may not rise or set over an incarcerated inguinal, umbilical or incisional hernia.

This means: In case of an incarceration, surgery is indicated immediately!

Inguinal hernia expert
In the case of an inguinal hernia operation, a plastic mesh is used to permanently close the hernia gap.

Inguinal hernia: Diagnostics

If there is a reasonable suspicion of inguinal hernia, we will be happy to help you at our locations in Hamburg! The diagnosis begins with a personal consultation – at the Hamburg Hernia Center you will only meet hernia specialists.

Together, we will shed light on your symptoms and any pre-existing conditions. By palpation, we determine how large your hernia already is.

General examinations

If hernia surgery is recommended, you should consult a specialized hernia center. But your primary care physician also plays an important role. Especially helpful if you are not from Hamburg: The necessary preliminary examinations (ECG, blood test) can take place at the family doctor.

Developed in Hamburg: Dynamic ultrasound

Dynamic ultrasound is particularly helpful in diagnostics. Prof. Henning Niebuhr – one of the head physicians in our Hernia Center – was instrumental in developing the procedure. Dynamic ultrasound is very precise and shows the hernia or its size and texture in a very revealing way. In our practices and clinics in Hamburg, we generally dispense with more complex, sometimes stressful imaging procedures.

Inguinal hernia treatment

In general: A hernia can only be cured with surgery. Without surgery, the hernia gets bigger and bigger. There is also the risk of the hernia becoming incarcerated – as is the case in 1 to 3% of all abdominal wall hernias.

In our hernia center, we have a wide variety of surgical methods at our disposal. We operate in five clinics throughout Hamburg. A specialist is by your side throughout the entire treatment.

We decide individually which inguinal hernia surgery method is the right one. What is important is where your hernia is located and what its nature is. Also, the type of surgery depends on individual life circumstances, physical condition and concomitant diseases.

Inguinal hernia surgery with synthetic mesh

An inguinal hernia is usually closed with a synthetic mesh. Repeat breakage is thus much less likely than with suture closure. In our hernia center we use modern, very well tolerated meshes. We always insert the meshes outside the abdominal cavity.

Inguinal hernia minimally invasive surgery

Inguinal hernia surgery with small incisions: At the Hamburg Hernia Center, we primarily recommend minimally invasive surgical methods. Our preferred surgical procedures for inguinal hernias are the TAPP and TEP method. Both surgical methods require only tiny incisions in the skin.

Minimally invasive procedures – Advantages:

At our hernia center in Hamburg, we make use of the following advantages of minimally invasive surgery:

  • Less pain than after open hernia surgery
  • Patients are able to bear weight again significantly faster
  • Special advantage for double-sided hernias: both inguinal hernias can be treated in one operation

When to operate openly?

Open inguinal hernia surgery is for example suitable for patients with:

  • anesthesia risks
  • major previous operations on the lower abdomen
  • very large inguinal hernia or testicular hernia
  • recurrence of inguinal hernia (repeated hernia) after endoscopic surgery
  • Liver cirrhosis and abdominal fluid after liver transplantation

Open surgery is also recommended for patients who desire local anesthesia.

Inguinal hernia expert
Hernia specialists: Together, our team can look back on more than 30,000 surgeries – inguinal hernias are the most common diagnosis.

Inguinal hernia surgery: Which method?

Inguinal hernia surgery – which method is the right one? Where possible, we use minimally invasive surgical methods. The endoscopic TAPP operation and the similar-sounding TEP operation, for example, offer gentle treatment.

At the Hamburg Hernia Center, we collectively look back on more than 30,000 hernia surgeries, including inguinal hernia operations using the TAPP and TEP methods. We see slight advantages for TAPP (transabdominal preperitoneal plastic).

TAPP procedure for inguinal hernia

Inguinal hernia surgery with laparoscopy – our procedure of choice in Hamburg: In TAPP surgery, a laparoscopy is performed first. This allows us to see the hernia or hernia gaps precisely and prepare the mesh insertion. We then insert the mesh between the peritoneum and the abdominal wall. In addition to the inguinal hernia, it may close other weak points in the inguinal region.

Advantages of the TAPP operation

  • Tiny skin incisions, minimal scarring (MILS procedure)
  • Abdominal endoscopy included: free view of all abdominal organs (including small and large intestine), possible adhesions between intestine and abdominal wall can be diagnosed and removed
  • Special advantage in case of double inguinal hernia or additional umbilical hernia: only one surgery required

TEP surgery

A variant of minimally invasive surgery is TEP (Total Extraperitonal Patchplasty). At the Hamburg Hernia Center, we recommend TEP especially for bilateral hernias or repeated hernias after open inguinal hernia surgery.

During TEP surgery, a balloon is inserted down the abdominal wall and inflated. This lifts the peritoneum away from the rest of the abdominal wall and creates space in front of the abdominal cavity. CO2 gas is used to keep this space open so that a 10×15 centimeter mesh can be inserted behind the abdominal wall and in front of the peritoneum. All hernia gaps in the groin region are closed in this way.

As the gas is released, natural abdominal pressure pushes the peritoneum against the mesh, holding it in place without metal clips or sutures. The hernia is closed, and the inguinal region of the abdominal wall is stabilized.

MILS procedure

Inguinal hernia surgery virtually without scars: In the MILS procedure, the punctures are extremely small. There is no need for suture closure, so there are no cosmetically relevant scars.

Milestone reached in Hamburg

Until 2008, 5 mm was still considered the lower limit of minimalization in inguinal hernia surgery. However, with the Hamburg University of Applied Sciences (HAW), Prof. Henning Niebuhr has further developed high-strength 2 mm instruments. This means that lateral punctures to the abdominal wall can now be kept to a minimum during inguinal hernia surgery.

The punctures are so small that a suture closure is not necessary. Only the small hub incision is sutured into the skin with a thread. This dissolves itself, eliminating the need for suturing after hernia surgery.

Experts refer to this particularly gentle procedure as Micro Invasive Laparosocopic Surgery (MILS).

Prof. Dr. med. Henning Niebuhr mikro invasive Hernienchirurgie

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Micro Invasive Surgery (only available in German)
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No visible scars
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Inguinal hernia surgery: open procedures

At the Hamburg Hernia Center, we prefer minimally invasive surgical methods. However, an endoscopic method is not always advisable.

For example, after major previous operations on the lower abdomen or intestine with adhesions. Then we recommend open surgery according to Lichtenstein. In case of large inguinal hernia (or testicular hernia), the Lichtenstein technique is also recommended.

Lichtenstein OP

Any abdominal organs located in the hernial sac, such as a loop of bowel, are first carefully pushed back into the abdominal cavity into the correct position. Then the hernia gap of the abdominal wall is securely closed and stabilized with a synthetic mesh. The abdominal wall is fully loadable again after only a few days.

At our hernia center in Hamburg, we operate on many people of advanced age. For them, open surgery according to Lichtenstein may be suitable, as it is possible under local anesthesia.

This form of inguinal hernia surgery is also reasonable for very elderly patients with severe concomitant diseases.

The Lichtenstein operation is not suitable for femoral hernias.

Shouldice procedure

An inguinal hernia usually occurs in people of middle age. But younger people are also affected. We also operate on young patients with small hernias in our hernia center in Hamburg according to the Shouldice procedure.

In this case, the hernia is repaired with suture closure of the abdominal wall layers. Any organs located in the hernial sac are pushed back into the abdominal cavity. Then the hernia gap is closed. The surgery is possible under local anesthesia.

The risk of recurrence of the hernia is significantly increased compared to the mesh methods – by five percent compared to less than one percent after five years. This is what our own follow-up investigations have shown.

In hernia surgery with suture closure, the abdominal wall is able to bear maximum weight again after about six weeks.

Shouldice surgery is not suitable for femoral hernias.

Inguinal hernia surgery under local anesthesia

We also offer open surgery (Lichtenstein and Shouldice) under local anesthesia in our partner clinics in Hamburg. Anesthesia is not administered via the spinal cord. We only anesthetize the affected groin region using local anesthetic. If desired, we will also administer a sleeping pill.

Local anesthesia has the lowest risks of all anesthesia procedures. You can – and even should – get up, eat and drink immediately after hernia surgery.

Local anesthesia is particularly recommended for very elderly patients. In addition to the inguinal hernia, there are often various concomitant diseases with risks of anesthesia. Under local anesthesia, safe inguinal hernia surgery is possible even then.

Inguinal hernia surgery: What happens next?

Inguinal hernia – and then? What happens after the operation? Generally speaking, an inguinal hernia is quickly repaired and those affected are able to bear weight again after a short time. Immediately after the operation, everyday activities (e.g. dressing and undressing, body hygiene) and light exercise are possible.

Wound healing usually requires 7 to 10 days. Then, at the latest, you can return to physical activity and, for example, swimming, jogging, cycling and lifting up to 20 kilos. Heavy physical work is possible again 3 to 6 weeks after inguinal hernia surgery, depending on the surgical method.