Abdominal hernias: every patient deserves tailored care!

In the treatment of abdominal hernias, absence of pain and better quality of life are the pillars of current and future therapy. Prof. Giampiero Campanelli, Professor of General Surgery in Milan , Founder and Director of the Hernia Center in Milan, an internationally renowned surgeon , talks about it

Prof. Campanelli, what is an abdominal hernia?

The hernia of the abdominal wall, in particular the inguinal one, is nothing more than the escape of the intestine, of the fat that covers it and / or part of it and of the peritoneal membrane (sac) through pre-existing channels (inguinal, umbilical and crural) or wounds, injuries, surgical incisions and / or overalls of the abdomen wall (in this case we talk about laparocele). The cause of these hernias is always a coincidence between a constitutional and / or acquired weakness (e.g. in the case of laparocele) of the tissues and physical activity. However, this does not mean that they are congenital: congenital hernias are only those of babies at birth and are due to a defect in fetal development which, in some cases, can persist until adulthood.

Can physical activity and exertion be responsible for the hernia?

With regard to efforts, these can be assessed as contributing factors, always coinciding with a constitutional weakness of the tissues; while in the case of physical / sporting activity, the so-called ” sports hernia “, or pubalgia , must be clearly distinguished from the actual inguinal hernia.

Sportsman’s hernia: what is it about?

In reality it is not a real hernia, since there is no leakage of the intestine with its sac, and associating it only with sportsmen is wrong because many times the general population is involved in normal physical activity. It is for these reasons that, for several years, I have proposed to the international scientific community a new denomination, “Pubic Inguinal Pain Syndrome” (in English Pubic Inguinal Pain Syndrome, PIPS), which best lends itself to clinical, anatomical and etiological reality. It is in fact a syndrome caused mainly by three factors: a slight weakness of the inguinal structures, a stiffening of the insertion tendons of the rectus abdominal and adductor long muscles and the compression of the sensory nerves of the area.

Inguinal pain in women: can it be Pubic-Inguinal Pain Syndrome?

This type of pain in women is very common, but it can result from several causes: crural hernia , PIPS, endometriosis of the round ligament of the uterus. Each of these conditions requires separate therapy, although the affected area is always the groin area. For this reason, it is clear that, before establishing the therapeutic procedure, a precise and correct diagnosis must be made, in order to avoid the failure to resolve these situations which negatively affect the daily lives of women.

How to approach an abdominal hernia: the expert’s secrets

Today, the approach to these conditions requires a differentiated and vast knowledge of different topics and a diagnostic-physiotherapeutic-surgical collaboration (sometimes integrated) that must be perfected with a real super-specialization. In fact, only a great experience can guarantee the patient the best therapy for his individual case. This principle, known by the name of ” tailored surgery ” ( tailored treatment), represents an essential concept in current and future hernia surgery. Each phase of therapy (anesthesia, hospitalization, surgical approach, technique and / or prosthesis used, postoperative, etc.) must be tailored for each patient, according to his lifestyle, age, anatomy and his expectations.

So there is no absolute best technique or prosthesis?

Exactly. Each treatment of primitive uncomplicated inguinal hernia provides parameters to be followed which must however be “tailored” for each patient. With regard to prostheses, there is no ideal type or better than another and the same goes for techniques. It is true that the study and research on materials (synthetic, biological, absorbable, non-absorbable or partially absorbable) are essential, as well as their interaction with cells and tissues, in order to improve more and more tolerability in human tissues . Precisely for this reason I decided to found and direct the first (and at the moment) only university Research and High Specialization Center on Abdominal Hernia Surgery and the Hernia Center.

Primary inguinal hernia: what process to follow?

  • Routine use of local anesthesia, i.e. the execution of punctures in the area to be operated to guarantee the patient perfect tolerability and no pain;
  • Gentle approach to tissues, given that the patient is awake, respecting his anatomy in order to reduce sensations and postoperative consequences;
  • Use of nets and prostheses of all compositions, textures, materials, etc. so you can choose the one most suitable for the patient and choose a type of fixation possibly without sutures, using a special glue; also repairs without prostheses or nets depending on the type of patient anatomy and pathology;
  • The laparoscopic surgery or robotics of primitive inguinal hernias is indicated only in the case of bilateral inguinal hernias;
  • Day Surgery regime, i.e. the organizational, clinical and control capacity and possibility of being able to discharge the patient after a few hours.

Are complications frequent following surgery?

In general, the treatment of uncomplicated inguinal hernia does not cause the patient particular pains or impediments, but if performed in an approximate, erroneous or non-specialist way it can give rise to complications that can compromise the patient’s quality of life. For this reason, I consider a super-specialization fundamental. Examples of sequelae can be relapses, multiple relapses, chronic postoperative neuralgia, all fearsome situations that initiate diagnostic-therapeutic paths that can last for years and that drag the patient into a sometimes dramatic vicissitude.

Is it possible to avoid or reduce these complications?

Once again, I must say that experience, in practical, numerical and cultural terms, plays an essential role: correct approaches, flawless anesthesiological and surgical techniques, accurate anatomical knowledge, as well as the ability to adopt different solutions are fundamental prerogatives to guarantee a clear intra and postoperative. This is precisely why I decided to organize the Hernia Center in Milan, made up not only of a team of surgeons but also of numerous other specialists, to allow a 360º approach for all hernial pathologies, in order to identify the correct treatment. for each patient and ensure a good quality of life.

 

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