What are hernias?

Hernias (or otherwise abdominal wall hernias – inguinal hernias, umbilical hernias, etc.), are among the most common diseases of general surgery. The surgeries to restore them are among the most frequent surgeries, with tens of millions of such operations performed annually in the West world.

Στην κήλη, η οποία είναι μια καλοήθης πάθηση, δημιουργείται ένα χάσμα στο τοίχωμα, της κοιλιάς, από το οποίο προβάλλει κάποιο κοιλιακό σπλάχνο (έντερο, επίπλουν, και πιο σπάνια η ουροδόχος κύστη  και άλλα όργανα). 

Είναι πιο συχνή στους άντρες, με συχνότητα εμφάνισης  25%, ενώ στις γυναίκες που θα χειρουργηθούν η επίπτωση είναι 1 στις 50.

What are the types of hernia?

Depending on the location of the organ’s projection in the body, it is also called a hernia. Thus we have:

• Inguinal hernia (about 70% of all hernias)
• Postoperative hernia
• Umbilical hernia
• Femoral hernia
• Spiegel hernia
• Epigastric hernia

What are the causes that favor the creation of a hernia?

• Conditions that increase intra-abdominal pressure (obesity, chronic cough, constipation, difficulty urinating due to prostatic hyperplasia, multiple births, heavy manual work)
• Wound
• Previous abdominal operations (mainly open surgeries). These occur due to weakening of the abdominal wall along the scars. These hernias are called postoperative.
• Elderly
• Malnutrition, poor nutrition
• Smoking
• Disorder in collagen metabolism
• Congenital predisposition (from birth)

What are the symptoms of hernia?

At first it may just be a small bump that does not cause pain. Gradually this can increase and become a permanent nuisance. . Coughing or exercise can aggravate it. Usually it is unclassifiable, meaning its content returns to its place by itself. However, in some cases it can develop into irreversible and finally cause engorgement.

Is the hernia dangerous?

A hernia can become dangerous if it becomes tight. The stricture will cause intense, sharp, and excruciating pain, and requires immediate surgical treatment to prevent ischemia and necrosis of the projecting organ.

What is the treatment of hernia?

When a hernia has formed, the only treatment is surgical repair. The purpose of the surgery is to close the gap in the abdominal wall and reinforce it with a mesh, in order to reduce the possibility of its recurrence.

 

What is Robotic Hernia Repair?

The most modern and effective method of dealing with hernias today is robotic mesh repair.

The advantages of robotics are impressive compared to older methods, classic open or laparoscopic surgery.

The 3D fixed camera gives an excellent visualization of the structures and the surgical field and the great flexibility of the surgical tools that simulate the human hand but on a microscopic scale facilitate the surgeon and allow him to perform the operation bloodlessly and with great precision.

The entire abdomen is also examined, so more than one hernia can be repaired at the same time (eg inguinal hernias).

It is the method of choice and is recommended in the guidelines for the treatment of hernia recurrences after open surgeries.

It is also ideal for the rehabilitation of athletes’ hernias and “abdominal-adductor syndrome”). Adductor strain is the most common musculoskeletal cause of groin pain in athletes. Groin injuries are particularly common in athletes and account for 2 to 5% of injuries. Other causes of groin pain include posterior inguinal tendon rupture, iliopsoas bursitis, fractures, nerve compression in the area, and “snapping hip” syndrome.

Early diagnosis and treatment are crucial to prevent these ailments from becoming chronic, with devastating consequences for the athletes’ careers.

 

Is it necessary to use a mesh and which mesh is the best?

In any case, a mesh is placed to reduce the risk of recurrence. The small, almost invisible, 5-6 mm incision through which the robotic tools enter is made only in the skin and not in the muscles as required in classic open surgery.

Modern treatment of hernias allows us to use absorbable light-weight meshes,

These meshes are completely absorbed in a few months, so no synthetic material remains in the tissues. This is particularly important for patients with diseases who may undergo other operations in the future and in surgeries where the environment is not completely sterile.

Also, these meshes are more resistant to infections and eliminate the sensation of a foreign body.

 

What are the methods of repair?

Two different techniques are widely used:

Transabdominal preperitoneal approach (TAPP): the technique requires entering the peritoneal cavity (where the organs are located), opening the peritoneum from inside the abdomen, preparing the hernia, placing the mesh in the gap and closing the peritoneum with a mesh overlay.
Totally extraperitoneal approach (TEP): this technique avoids entering the peritoneal cavity. Instead, it is performed outside the peritoneal cavity, in a plane just above the peritoneum. The hernia gap is located and repaired by placing a mesh.

The goal is painless treatment with the lowest recurrence rates and the fewest complications and infections.

Which technique is better?

Different surgeons usually have their own preferences regarding laparoscopic repair techniques. In the hands of an experienced surgeon, both techniques have excellent results.

What are the advantages of Robotic Hernia Repair?

Recovery after surgery is immediate. The patient is mobilized 1-2 hours after surgery and is usually discharged the same day. Patients return to their daily lives within a few days. We also have other important advantages, such as:

• Minimal tissue injury, as abdominal incisions are avoided
• Minimal blood loss
• Almost no postoperative pain
• Reduction of postoperative complications
• Minimal formation of adhesions
• Reduction of the risk of hernia recurrence, since access to the site is excellentRapid recovery and immediate return to daily activities and mild sports (e.g. walking, jogging) within 1-2 days
• In professional athletes, full return to professional sports activities occurs within 4-6 weeks after the operation, (as opposed to the 3-4 months required after open surgery.

 

I have had a huge hernia for about 30 years – can I fix it robotically?

In experienced hands, robotic repair is the method of choice, especially in cases of large or complex hernias. The use of the robotic system ensures precision, flexibility, control and great ease of surgical movements, resulting in better access to the problem area.