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Experienced medical specialists commit themselves personally or in a team for you in the PAN Clinic at the Neumarkt. 19 different medical faculties. Outpatient, in-patient and minimally invasive surger. Medical consultation, diagnosis and treatment are available directly and on a high level of standard. Modern and highly specialised therapeutic methods. Patient-friendly environment. Hotel-like comfort. Engaging nursing staff, who have benefited from highest quality training, deliver attentive medical care. Every medical specialist is on stand-by in order to help in case of emergencies. All of our doctors are highly qualified.


Hernienzentrum Köln

Zeppelinstr. 1

50667 Köln / Neumarkt-Galerie

Tel: 0221 / 27 76 - 431



What defines Hernias?

Inguinal Hernias

The term inguinal hernia describes hernias situated directly above the inguinal ligament, a tendon - like structure made out of connective tissue, which is part of the connection between abdominal muscles and the pelvis. The inguinal canal is located at this point, where under normal circumstances the female mesosalpinx of the uterus or the male spermatic cord passes through the abdominal wall.

What are the causes of inguinal hernias?

The inguinal canal represents a natural point of weakness for the abdominal wall. This affects males more often than it does females. As a result inguinal hernias are diagnosed in male patients much more frequently. In addition every man exhibits a protuberance of the peritoneum into the inguinal canal ultimately stretching as far as the testicles, before he is even born. This protuberance deteriorates in its entirety shortly before birth. This deterioration, however, is not always completed before birth and eventually forms into the hernial sac of the inguinal hernia. Other types of inguinal hernia emerge from increased pressures in the abdominal cavity, as a result of, for example, chronic coughing, frequent pressing or other strenuous physical activities.

By which symptoms is the inguinal hernia best characterised?

The most common symptom is a swelling of the abdominal skin, which occurs quite suddenly, most of the time without any pain, located next to the protuberance of the pubic bone. Most of the time, this swelling is only recognisable when the patient is either standing up or by pressing down onto the affected area. While the patient is lying down, the swelling disappears completely. A full bladder or intestines occasionally lead to slight pain. Often patients have also discovered foreign body sensations whilst sitting down. If the swelling stretches as far as the scrotum and is visible trough the patients clothing from the outside then the hernias have existed and developed for quite some time. Once the hernias have reached this stage, the swelling usually does not subside when the patient lies down. The patients then have to lie down and massage the organs that have been captured in the hernial sac, back into the abdominal cavity. These type of hernias often cause discomfort during pressing, bowel movement or passing water.

What does the term “incarcerated” hernia imply?

Those organs that have been trapped in the hernial sac (most often the small intestinal loop) cannot be brought back into the abdominal cavity, neither by the patient nor by the doctor, if the hernia is incarcerated. The patient will suffer from severe abdominal pains, which are, on the one hand, caused by the fact that the intestine is incarcerated and thus obstructed. On the other hand, however, the blood supply of the intestine is also obstructed due to the pressure from the outside. The lack of blood supply will lead to a necrosis of the part of the intestine that is captured in the hernial sac within a matter of only a few hours. Thus an emergency operation is highly necessary in such a situation.

When and how will an inguinal hernia be treated?

The only method to successfully treat an inguinal hernia is by way of surgery. In order to by-pass time, a hernia truss can also be used in exceptional cases. These method (truss), however, is useless in the long-term. If used for several years, it can even cause more difficulties during surgery at a later stage due to damage caused by pressure in the abdominal wall. The date of the operation is determined by factors such as the degree of discomfort, the size of the hernia and the tendency of incarceration. Of course each operation has to be determined individually in accordance with the patients’ needs. Other determinative factors include activities that the patient has planned, such as travelling. In addition the fact that inguinal hernias grow over time and that operations, which are scheduled, are always better than those which are carried out on an emergency basis, lead to the conclusion that the patient should undergo surgery within the space of six months of being diagnosed.

Umbilical Hernias – Omphalocele

Umbilical hernias are the second most common hernias of the abdominal wall after inguinal hernias. An umbilical hernia of a newborn baby, however, is the exception to the rule. Infantile umbilical hernias rarely lead to an incarceration and can thus be described as the only hernias that heal spontaneously: 98 % of all hernias diminish within the space of 2 years.

Once the child has passed the age of two, all umbilical hernias should be surgically removed, because every fourth hernia that is not operated on leads to an incarceration within the following years. An umbilical hernia which includes the incarceration of parts of the intestine poses a life threatening situation to the patient even today in this day and age.

If the contents of the hernial sac are jammed (rarely occurs) and it is not possible to push it back into the abdominal cavity, an operation needs to be carried out immediately without any delays. The patient will suffer severe pain, nausea and vomiting in such a situation.

Surgical Procedure

The operation involves either closing the gap located at the navel or the abdominal centre line which was caused by the rupture. It is quite possible that over the years small parts of the peritoneum have grown into the gap created by the rupture. The gap usually has a diameter of less than 2 cm and will be sutured shut provided the patient is slender and young.

The abdominal wall should be strengthened with a synthetic net, if a larger defect is at hand, in order to reduce the risk of a relapse. Thus we use a polypropylene net to conduct the onlay-technique or more commonly a net that features 2 different sides to carry out the inlay-technique. One of the sides of the net possesses a special coating, which prevents further growths between net and the contents of the abdomen. For these reasons the coated side is inserted into the abdomen first.


Immediately after surgery the patient will be able to conduct normal day-to-day activities (such as clothing him/herself, personal hygiene, walking). Eating and drinking are also possible straight away. A patient will be able to resume normal physical activities, such as household chores, easy work in the garden, cycling and driving a car, once the wound has healed at the latest (approx. 10-14 days). More difficult or serious physical activities may be taken up again approx. 2-4 weeks after surgery, if the patient feels capable of doing so.

Abdominal Wall / Incisional Hernia


These hernias occur if the patient has discovered a swelling in the region of a scar on the abdominal wall from a previous operation. This swelling becomes more noticeable, particularly when the patient presses, coughs or sits up from previously lying down. The swelling is usually less recognisable in the latter position.


After an operation has been completed in the abdominal cavity, the abdominal wall is sutured shut, including the latter’s layers of muscle and connective tissue. These sutures are meant to create a permanent seal and firm scar. It is, however, possible for the scar to weaken in 10-15 % of all cases, creating a gap in the abdominal cavity. The contents of the abdomen, e.g. intestines or fatty tissue, are thus more prone to push through this gap. The following factors increase the risk of suffering from an incisional hernia: misuse of alcohol or nicotine, acute or chronic respiratory diseases, artificial respiration occurring after an abdominal operation, ascites, weakened connective tissue, intestinal obstruction, protein deficiency, cough, kidney function disorder, tumours, being overweight, wound infection, diabetes mellitus, repeated abdominal wall incisions, inaccurate wound closure technique.

Is surgery necessary?

If the contents of the hernial sac have incarcerated themselves (rarely occurs) and it is not possible to push them back into the abdominal cavity anymore, an operation needs to be conducted immediately (within 4-6 hours) as an emergency. The patient will suffer from severe pain, nausea and vomiting in such a situation. Those incisional hernias, which are characterised by a relatively small gap caused by the rupture, are particularly prone to incarceration. Due to this imminent danger being present constantly, it is advisable to undergo surgery. Should the skin in the incarcerated area undergo any changes, e.g. become thinner or even inflamed, an operation should be a necessary priority.

As for all other soft tissue ruptures, it needs to be stressed that these abdominal wall / incisional hernias will not diminish, quite the opposite, they will in fact gain in size over time. Thus it is important to highlight the fact that particularly younger patients should not rule out surgery immediately.

Surgical Procedure

If the ruptures are less than 3 cm in size, it usually suffices to suture the edges of the rupture back together. Various types of research, however, have shown that this surgical procedure can cause repeated ruptures, particularly if the rupture is bigger than 3 cm. This is due to the fact that the patient’s tissue already suffers from a dysfunctional scar formation and thus repairing the defect with the patient’s own tissue does not provide a promising outlook onto the situation. It is only possible to achieve long-term stability by covering the gap, which was caused by the rupture, with a synthetic net. The determination of the issue into which layer of the abdominal wall the synthetic net is planted into during the operation, is dependant on several different factors. This issue can only partially be resolved during the actual surgery. If the rupture is quite large in size, the net needs to overlap with the hernial orifices by 5 cm in all directions, in order to avoid further ruptures in the future. Thus these operations can only be conducted under general or spinal anaesthesia. It is possible for the patient to feel foreign body sensations in the abdominal wall, if large synthetic nets were implanted.

The risk of relapsing has decreased significantly since the medical world started using nets during procedures. The size of the rupture as well as several other factors, determine whether the procedure can be conducted on an out-patient basis or whether a short in-patient stay is required. This will all be clarified during your consultation with us.


Immediately after surgery the patient will be able to conduct normal day-to-day activities (such as clothing him/herself, personal hygiene, walking). A patient will be able to resume normal physical activities, such as household chores, easy work in the garden, cycling and driving a car, once the wound has healed at the latest (approx. 10-14 days). More difficult or serious physical activities may be taken up again approx. 3-6 weeks after surgery, if the patient feels capable of doing so.