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Procedure with mesh

A surgical procedure with mesh, as is mostly used today, has two major advantages: a significantly lower risk of recurrence and a faster ability to bear weight after the operation. Already after a few days, the patient can do everything again after a hernia operation with mesh. In general, patients have less discomfort because with the meshless procedure the sutures can cause tension in the body. Very rarely, infections or inflammations occur, with which the body reacts to the foreign material. In these cases, the infection or inflammation is treated but the mesh is left in. In extremely rare cases, the effect of the foreign body (edges or the attachment of the mesh) can also cause nerve disorders or scar nodules that cause pain.

Different meshes for hernias

Standard are polypropylene nets, which are very light and large-pored and do not cause allergies. There is a plethora of different nets that we use in the operations. There are nets that are specially coated so that they cannot stick to the intestine or nets where parts dissolve over time but a certain basic structure remains for stabilisation in the body. Certain nets like the “PHASIX” are completely biodegradable. They are broken down by the body over a period of 15 to 18 months and replaced by the body’s own stable connective tissue.

 

In some circumstances we work with several different meshes at the same time. With a kind of sandwich technique, a net is placed on the side of the intestine, which cannot stick to the intestine due to the special coating. A net is placed in an outer layer that later dissolves completely. Under the covering layer we use a third net which is permanent and ensures stability.

 

Before the operation, it is usually still unclear which nets we use best. We have all the nets in stock in the operating theatre and then decide during the operation what is most suitable for the treatment.

TAPP

TAPP stands for Transabdominal Preperitoneal Plastic (Transabdominal Patch Plastic) and is a minimally invasive surgical procedure in which the weakened abdominal wall is reinforced with mesh after hernia repair.

First, a high-resolution camera is inserted through a small incision at the edge of the navel and the abdominal cavity is filled with CO2 gas while being viewed on the screen. This creates a working space for the surgeon.

The two other small stitches, to the right and left of the navel, are used to insert the surgical instruments. In the TAPP technique, the peritoneum is cut open and the surgical tools pass through the abdominal cavity to the site of the hernial orifice. The hernia sac is released from the hernial orifice and pushed back. At the site of the hernial orifice, a sufficiently large plastic mesh is placed over the peritoneum. In certain cases, surgeons fix the mesh to the abdominal muscles with the help of clips or special glue. Afterwards, the previously cut open peritoneum is closed again with the help of a suture.

 

For incarcerated hernias, the TAPP technique is mainly used. For inguinal and femoral hernias, as well as for large umbilical hernias, we always advise endoscopic treatment – whether with TAPP or TEP. In the case of incisional hernias, treatment is very individually tailored to the case.

 

We only perform the TAPP technique under general anaesthesia. Please note the important points regarding aftercare.

 

TEPP / TEP

TEP stands for Total Extraperitoneal Plastic and is written TEPP (Total Extraperitoneal Patch Plastic) in the English variant.

 

The TEP technique is also minimally invasive and also works with a plastic mesh for stabilisation. The difference to the TAPP technique is that in this case the peritoneum is not opened and the procedure is performed in the abdominal wall.

 

An artificial space is created between the peritoneum and the muscles via the first incision at the belly button with the help of an inserted rod or balloon. CO2 gas is now blown into this created gap to enable a better view. A special camera is also inserted at the same point to view the hernia. The necessary surgical instruments are inserted through two further incisions, one on the right and one on the left of the navel.

 

The hernia sac is detached and the hernial orifice is covered with a plastic mesh. If necessary, the mesh can be additionally fixed with the help of a suture, clips or tissue adhesive. Usually the mesh stays in place without any problems due to the internal abdominal pressure.

 

The surgeon works here in the intermediate layer between the peritoneum and the muscle wall, where the mesh is also inserted. It is possible to work without cutting the tissue and suturing, which is gentle on the tissue. The TEP technique is somewhat more demanding to learn than the TAPP technique. Basically, however, it depends on the surgeon which technique he prefers.

 

We only perform the TEP technique under general anaesthesia. Please note the important points regarding aftercare.

Lichtenstein

The Lichtenstein method is a surgical procedure with mesh that is often used for inguinal hernias. In the first step, the abdominal wall muscles are opened with an approximately 5 – 8 cm long incision transversely above the inguinal ligament. In the case of a direct hernia, which bulges against the outside of the body, the hernia sac can be brought directly back into the abdominal cavity. However, if it is an indirect hernia that protrudes into the abdominal cavity, the hernia sac must be separated from the spermatic cord and also opened. In most cases, there is only fatty tissue in the hernia sac. If there are also parts of the intestine in it, it must be examined whether they were cut off from the blood supply. The hernia contents are returned to the abdominal cavity and the hernial orifice is closed with a suture. In addition, the surgeon reinforces the hernial orifice in the abdominal wall with a plastic mesh which is placed between the inner and outer abdominal muscles. The mesh is fixed with a suture to the inguinal ligament and the oblique abdominal muscle. However, there are also meshes that fix themselves with a hook or are self-adhesive.

 

Usually the procedure is done under general anaesthesia. However, partial anaesthesia or local anaesthesia may also be possible. The patient should take it easy for about 3 weeks after this operation. Please note the important points about aftercare here.

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