Hernia surgery: why contact a super-specialist?

Prof. Giampiero Campanelli, primary surgeon of  General Surgery in Milan , explains why he decided to structure a center specialized in abdominal hernia surgery and how the treatment of this condition is evolving thanks to increasingly personalized techniques

Prof. Campanelli, what is the Hernia Center and why can we say that the concept of hernia surgery has been revolutionized in recent years?

We have founded the first, and for now only, university research center dedicated to hernia surgery , which for the part of scientific research is based at the University of Insubria and whose armed arm is the Hernia Center, at the Istituto Clinico Sant’Ambrogio and La Madonnina Clinic in Milan. Hernia surgery has become a super-specialization and it is therefore appropriate that it be performed by dedicated surgeons. The goal is to create surgical excellence in an extremely frequent but often overlooked field of intervention.

Why overlooked?

Because in the past, but unfortunately also today,  hernia surgery  is performed without in-depth knowledge and left to improvisation, with the consequence that the results are often unsatisfactory, on the one hand creating negative sequelae for patients and on the other a increase in health care costs.

Hernia Center: a first-rate center for the treatment of abdominal hernias

The Hernia Center was born with the idea of ​​being able to provide 360º the skills needed to solve any possible problem of the hernias of  the abdominal wall : from simple primitive inguinal hernias never operated to recurrences; from ventral hernias (umbilical and epigastric) to incisional hernias (  laparoceles ); from the extreme situations of wall disasters to the so-called hernias of the sportsman; from situations of chronic postoperative pain to postpartum abdomen floppy with the relative diastasis of the rectus muscles.

Prof. Campanelli, can you give us some examples?

Think of the woman who after the birth has a relaxation of the abdomen, an abundant skin fold, a small umbilical epigastric hernia, a situation that in addition to an aesthetic and functional problem can also lead to posture problems to the spine: it needs a complex intervention to obtain a perfect result. Another example is the pubic groin pain syndrome: the patient has a painful clinical onset, the ultrasound shows a hernia of a few millimeters (6-7mm), the general surgeon operates it but it is possible that in the postoperative period he has more pain than first, because that hernia is only one of the aspects of the syndrome, which in addition to the weakness of the posterior wall of the inguinal canal (it is therefore not a real hernia), is associated with a muscle-tendon and nerve compression problem. It is on these aspects that we must act primarily.

How does the Hernia Center operate?

A problem of this type must be addressed first in terms of knowledge, then with physiokinesitherapy aimed at reducing tendon compression and only if it does not work the patient should be referred to surgery, which in this case can provide for reinforcement of the posterior wall of  the inguinal canal.  with an ultralight or biological net and treatment on tendons and nerves.

Does this also have advantages on costs?

We can speak of the Hernia Center as a large cost-saving center: this approach leads to savings for the community, since these diseases are treated “comprehensively”, to use a term derived from the great American Hernia Centers. We start from the principle that each patient is different and we aim for surgery tailored to the individual subject, its anatomy, its expectations and needs. There is therefore no, and must not exist, a better prosthesis than another or a magical technique. Surgeons who adopt this approach or who propagate such unique solutions have no experience in the field and for this reason they “adapt” the patient to the only prosthesis or technique they adopt, when exactly the opposite is necessary: ​​modulate the approach on the individual case,tailored surgery “, in fact). But to do this, all the techniques, all the approaches, all the technical possibilities and all the possible prostheses must be in the hands and culture of the super-specialist surgeon.

Are there more complex cases?

An example are multiple recurrences or  wall disasters. Hernias and laparoceles, if not treated correctly the first time, can lead to complications and sometimes very long sequelae. Therefore extensive surgical experience is essential, such as ours based on over thirty years of thousands of cases (around 10,000) and supported by continuous research. The ultimate goal is now to introduce the robotic approach correctly and scientifically, when needed (which today is indiscriminately and unconsciously proposed by some without even the slightest global consideration of the problem), which can become a great advantage, because it succeeds to take advantage of the advantages of open surgery with the minimally invasive approach of laparoscopy, provided that it is carried out in an honestly competent and professional manner.


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