Inguinal hernia / Groin hernia

An inguinal hernia – also known as a groin hernia – is the most common type of abdominal wall hernia and usually presents as a visible swelling or bulge in the groin area. Inguinal hernias affect men more frequently than women but can occur at any age.

Inguinal hernias usually require surgical treatment. Depending on the findings and your preferences, we use the following methods:

Open techniques:
The operation is performed through an incision of approximately 6 cm in the groin. In most cases, a synthetic mesh is used to reinforce the abdominal wall (Lichtenstein repair). In selected cases, the inguinal hernia can also be repaired without mesh using a multilayer suture technique (Shouldice repair). We primarily choose open techniques when a minimally invasive approach is not possible or not desired – for example due to previous abdominal surgery. For patients who wish to avoid general anaesthesia for medical or personal reasons, we also offer this procedure under local anaesthesia.

Minimally invasive techniques:
The standard procedure for inguinal hernias is minimally invasive repair using a synthetic mesh. We perform the so-called TAPP (Transabdominal Preperitoneal Plasty) technique: the hernia is approached laparoscopically through the abdominal cavity, which is inflated with CO₂, and the operation is carried out through three small incisions measuring 5–12 mm. The mesh is placed preperitoneally – between the peritoneum and the abdominal musculature. The advantages include faster recovery, less pain, and fewer wound healing complications. In selected cases, we also use the Da Vinci Xi surgical robot.

Anterior abdominal wall hernias / Ventral hernias (Umbilical hernia & Epigastric hernia)

Umbilical hernias and epigastric hernias are among the most common hernias of the anterior abdominal wall. An umbilical hernia develops in the area of the navel – a natural weak point of the abdominal wall. An epigastric hernia occurs along the midline between the navel and the breastbone. If symptoms occur, surgery is the treatment of choice.

Open surgical techniques:
The incision is made directly over the hernia site. Small hernias of up to 1 cm are closed with a slowly absorbable suture. Larger hernias are reinforced with a synthetic mesh in accordance with current guidelines to minimise the risk of recurrence. We offer well-established techniques of preperitoneal mesh placement (PUMP) and retromuscular mesh placement (MILOS), both characterised by particularly small skin incisions.

Minimally invasive techniques:
For larger hernias, mesh repair can also be performed using a minimally invasive approach. Through several small incisions of approximately 10 mm, the hernia defect is closed from the inside and a mesh is placed either preperitoneally or retromuscularly. These techniques include laparoscopic procedures (eMILOS, eTEP) as well as robot-assisted operations (ventral TAPP, TARUP).

This allows the abdominal wall to be reinforced in a particularly gentle way using very large meshes. Which method is suitable for you depends on the type and size of the hernia, as well as your personal preferences and overall health – this is something we will discuss together at our practice in Vienna.

Incisional hernias

Incisional hernias develop as a late consequence of abdominal surgery when a new hernia forms in the area of a previous abdominal wall incision. They can become very large and, according to current guidelines, usually require mesh repair.

As with ventral hernias, treatment can be performed using either an open or minimally invasive approach. In the case of large hernias with a defect larger than 8 cm, preoperative preparation of the abdominal wall – for example with targeted injections – may be necessary. In complex cases, additional procedures such as component separation (partial release of the lateral abdominal wall muscles) may be required. When appropriate, we also use the Da Vinci Xi surgical robot. Incisional hernias are one of our main areas of expertise – especially in complex or previously operated cases, we are your specialist in Vienna.

Rectus Diastasis

Rectus diastasis – also known as abdominal muscle separation or diastasis of the rectus muscles – describes the separation of the straight abdominal muscles (musculi recti abdominis) along the midline (linea alba). It commonly occurs during or after pregnancy, but may also develop with age or increasing abdominal girth.

Typical symptoms include a visible bulge in the center of the abdomen – particularly when the abdominal muscles are tensed – and in some cases back pain or a general feeling of weakness in the abdominal wall.

Treatment begins with physiotherapy to strengthen the abdominal musculature. Surgery is only considered after a trial of conservative treatment or in cases of significant physical impairment. If rectus diastasis is combined with a hernia, we recommend simultaneous mesh reinforcement of the entire anterior abdominal wall – as rectus diastasis is considered a risk factor for further hernias.

The Da Vinci Xi surgical robot represents the next generation of minimally invasive hernia surgery. Thanks to its high-definition 3D camera system and instruments with seven degrees of freedom, it enables procedures with a level of precision that cannot be achieved with conventional laparoscopic methods – allowing us to perform even complex hernia repairs minimally invasively that previously required large open incisions.

We are both certified in the Da Vinci Xi and have together completed over 320 robot-assisted procedures. We use the Da Vinci Xi at Klinik Donaustadt for both major abdominal surgeries and specialized hernia operations – including large incisional hernias, complex ventral hernias, and selected inguinal hernias. At the Wiener Privatklinik – Vienna Private Clinic (WPK), we additionally have access to the Da Vinci X.

Not every hernia procedure requires robotic assistance. Whether we operate using a robot, laparoscopically, or open is decided together with you – individually, based on your findings, your preferences, and our experience. Our goal is always the safest and least invasive approach for you.

Whether a hernia should be operated on depends on various factors – and is always an individual decision that we make together with you. Surgery should be considered when:

• Symptoms such as pain, pressure, or other discomfort are present.
• The hernia is growing or has already reached a relevant size – in this case we recommend prompt evaluation.
• The hernia affects quality of life or limits everyday activities.
• Aesthetic concerns: in some cases, the decision to undergo surgery may also be made for aesthetic reasons if the hernia is perceived as unsightly.

A medical emergency exists when bowel or fatty tissue becomes trapped in the hernia – a condition known as incarceration. Signs include sudden severe pain, hardening of the hernia, redness or warmth of the overlying skin, and in some cases nausea or vomiting. If this applies to you, please go to a hospital emergency department immediately – do not hesitate.

Ultimately, every decision about whether and how to operate is individual. What is particularly important to us: we will also advise you honestly and directly if surgery is, in our view, not the right course of action. After thorough examination at our practice in Vienna, we are happy to discuss all treatment options and find the best approach together with you.

Hernia surgery has evolved rapidly over the past decades – with a wide range of sometimes highly complex surgical techniques that require in-depth expertise and regular practice. Our specialization in hernias allows us to offer the full spectrum of modern hernia surgery – from simple inguinal hernias to complex abdominal wall reconstruction.

Thanks to our many years of experience and around 200 hernia operations per year, we are able to provide you with a well-founded understanding of all the advantages and disadvantages of surgery. What is particularly important to us: we also give honest advice when surgery is not the right option. A well-coordinated, specialized team means greater safety for you, shorter procedures, and demonstrably better outcomes.

Our follow-up care is carried out in a structured manner as part of the Herniamed quality assurance study – with follow-up examinations after one, five, and ten years. This allows us to continuously monitor our long-term outcomes and consistently improve the quality of our treatment.