Hernia Surgery

At our university hospital, we offer the full spectrum of modern surgical treatment for hernias. This requires individualized care provided by a specialized team. In addition to expertise, documented by the Union Européenne des Médecins Spécialistes certification as FEBS, continuous quality control is essential, which is ensured through participation in the HerniaMed registry.

Initial consultation/examination

First, your symptoms and individual situation are assessed in a personal conversation, and the characteristics of the hernia are defined through a physical examination and, if necessary, radiological diagnostics (ultrasound, computed tomography). Afterwards, the possible treatment options (non‑operative, operative, and different surgical techniques) are explained along with their advantages and disadvantages, and a therapy plan is jointly determined.

Inguinal Hernia

These occur at all ages, from newborns to elderly individuals. Management options range from watchful waiting without surgery to classical suture repair (Shouldice technique) and surgical procedures using tissue reinforcement (implantation of a mesh prosthesis). The operations can be performed minimally invasively – laparoscopically or robot‑assisted, meaning with small incisions and camera technology (total extraperitoneal hernioplasty, TEP, or transabdominal preperitoneal hernioplasty, TAPP) – or conventionally, meaning through an open incision in the groin (Lichtenstein or Shouldice technique). The latter procedures can also be performed under local anesthesia rather than general anesthesia. When selecting the surgical method, individual patient preferences are naturally taken into account in addition to medical considerations.

Abdominal Wall Hernias

There are simple abdominal wall hernias—such as umbilical hernias or epigastric hernias—as well as so‑called incisional hernias. These develop after abdominal surgery and therefore vary widely in size. When choosing the surgical method, the location and size of the hernia as well as the individual patient’s anatomy are crucial. Minimally invasive techniques are generally preferred for larger hernias, as they are associated with a more favorable healing process. With the introduction of robot‑assisted surgery (da Vinci platform, Intuitive) in 2024, the proportion of minimally invasive treatments could be further increased.

The Rives‑Stoppa repair has been studied since the 1970s and involves closing the hernia defect with implantation of a mesh placed behind the rectus muscles (retro‑rectus position). In some places, this mesh position is also referred to as “sublay.” Even today, it remains the gold standard for the repair of incisional hernias, including its minimally invasive modifications.

The MILOS (“mini‑ or less‑open sublay”) procedure aims to close the hernia defect and implant a mesh behind the rectus abdominis muscles (retro‑rectus), but is defined by a skin incision of no more than 5 cm (“mini‑open”; up to 12 cm for “less‑open”) over the hernia site and the use of specialized instruments. The modified version using laparoscopic instruments is commonly referred to as e‑MILOS (endoscopic MILOS). MILOS is suitable for repairing small umbilical and epigastric hernias associated with rectus diastasis, as well as for treating incisional hernias.

Additional minimally invasive techniques for repairing incisional hernias with mesh implantation behind the abdominal muscles (retro‑rectus, retromuscular) include endoscopic totally extraperitoneal hernioplasty (eTEP) and the laparoscopic transabdominal approach combined with extraperitoneal mesh placement—meaning no mesh is implanted inside the abdominal cavity and there is no contact with the intestines (TARUP, laparoscopic Rives‑Stoppa, ventral TAPP).

For very large hernia defects, the procedures mentioned above are supplemented by the targeted division of specific abdominal muscle aponeuroses to reduce tension during closure of the defect and to create additional space within the abdominal cavity. These techniques are referred to as anterior and posterior component separation releases, and there is a confusing variety of abbreviations and synonyms for them (TAR; transversus abdominis release; Ramirez procedure; ACS: anterior component separation).

The laparoscopic and open IPOM technique (intraperitoneal onlay mesh = synthetic mesh placed inside the abdominal cavity) is now rarely used, because although it is easy to perform and offers good long‑term outcomes, it can be associated with rare but serious complications such as bowel injury.

Parastomal Hernia

Parastomal hernias are herniations that occur at the site of a stoma (artificial bowel opening). When reversing the stoma is not advisable, synthetic mesh implants are also used to repair the hernia defect. These procedures are generally performed using minimally invasive techniques (3D mesh, Pauli repair).

Rectus Diastasis

A separation of the rectus abdominis muscles (diastasis of the musculi recti) occurs with nearly all increases in abdominal girth. This condition usually resolves when the abdominal circumference decreases again, for example after pregnancy.
If a hernia is present in the thinned tissue between the abdominal muscles, this must be taken into account during hernia repair by reinforcing the tissue with a mesh implant. Whether the diastasis is surgically corrected at the same time depends on the abdominal circumference, functional symptoms, and cosmetic considerations.
In cases of pronounced skin folding, simultaneous abdominal wall tightening (abdominoplasty) may be considered. This procedure, as well as diastasis repair without an associated hernia, is performed by the colleagues at the University Clinic for Plastic, Reconstructive and Aesthetic Surgery (https://pci.tirol-kliniken.at).