Hernia Surgery

A hernia is a defect in the abdominal wall from which the contents of the abdomen protrude outwards from under the skin. Patients generally see a swelling and have discomfort or pain. Hernias are the most common surgical indication, and around 20,000 hernia operations are performed throughout Switzerland every year. The inguinal hernia is the most common, followed by hernia of the abdominal wall (e.g. umbilical hernias, scar hernias) flowed by rare causes such as flank hernia and diaphragmatic hernias.

At our centre for hernia surgery we offer you competent and tailor-made advice and diagnostics. Depending on the clinical picture and the individual requirements of our patients, we perform open (larger skin incision) and minimally invasive surgical techniques (keyhole surgery) in accordance with current scientific findings and guidelines. Our many years of surgical experience enable us to offer you a surgical technique tailored to your needs. For minimally invasive operations, in many cases we also use a latest-generation surgical robot (Intuitive da Vinci Xi) which uses a 3D image to allow us to use the instruments even more precisely and gently.

We perform our operations at our exclusive partner, Merian-Iselin-Klinik in Basel. This clinic located in the center of Basel is of high renown in north-west Switzerland.In addition, we have specialized in the treatment of sportsmen’s groin, chronic groin pain after hernia operations and rectus diastasis. These diseases are complex and must be treated together with other specialists and therapists. Here we can rely on a network of experienced sports physicians, physiotherapists, radiologists and pain therapists.

Our patients are also individually cared for and treated by us after the operation. We remain available for you at all times. Within the framework of our “quality-assured hernia surgery”, we also send out follow-up questionnaires after the operation in order to identify new problems early on and treat them professionally.

Leistenbruch Dartstellung

DGAV Zertifizierung

ZweiChirurgen are certified as a «Center of Competence in Hernia Surgery» by the DGAV e.V.

Inguinal Hernias

Open approaches

  • Operation without mesh (Shouldice)
  • Operation with mesh (Lichtenstein)

Minimally-invasive approaches

  • Operation in the preperitoneal space (TEP)
  • Operation with laparoscopy (TAPP)

Hospital stay: 2 days
Outpatient treatment in unilateral hernias if applicable

Inguinal hernias are the most frequent surgical disease worldwide. More than 20 Mio groin hernias are operated every year globally, in Switzerland more than 18’000 patients must undergo a groin hernia repair every year. The risk for developing an inguinal hernia is almost 30% in male patients. For women the lifetime risk is about 6-8 %. An inguinal hernia is characterized by a clearly visible and palpable swelling in the groin.

Most inguinal hernias only cause mild symptoms (dull pressure, swelling), an operation is rarely immediately necessary. However, over time the hernia will increase in size and the annual risk for incarceration is around 0.5-1%. Therewith, only an operation can cure the hernia. The operation of the inguinal hernia can be executed with an open incision in the groin (Lichtenstein repair) or laparoscopically with a camera (TAPP or TEP repair). In our center we predominantly perform the laparoscopic TAPP technique. Here, the mesh is inserted between the peritoneum and the inguinal wall covering the hernia orifice and reinforcing the backwall of the groin. The advantages of this technique in comparison to open techniques are less pain, fewer complications, and faster recovery to work and social life after surgery. In many cases we use a surgical robot (DaVinci system, Intuitive) which gives a better 3D image of the camera and is much more ergonomic for the surgeon. In well selected patients with small hernias, we can also offer a mesh free suture repair of the inguinal hernia (Shouldice operation).

The most frequent complication after inguinal hernia repair is chronic postoperative inguinal pain (CPIP). In general, around 6-8 % of patients suffer from CPIP one year after surgery, especially during exercising and work after inguinal hernia repair. The risk for CPIP can depends on certain risk factors, but also from the surgical expertise. This explains the fewer rates CPIP in specialized hernia centers such as ZweiChirurgen. We operate 500-600 hernias per year and have CPIP rates around 1%.

Umbilical Hernias and epigastric hernias

Umbilical hernias and epigastric hernias are the second most common hernia diseases. Men and women have a lifetime risk of about 10% of developing such hernias. Surgery is necessary if the hernia has reached a certain size or is causing discomfort. Small hernias (< 1 cm hernia orifice diameter) can be managed with a direct suture closure. According to current guidelines reflecting most recent studies, hernias (> 1 cm) should be treated with a defect closure and a supporting mesh, e.g. at the umbilicus in the “Per Umbilical Mesh Plasty”, so-called PUMP operation. The mesh is ideally inserted between the abdominal wall and the peritoneum (extraperitoneal mesh position). Using meshes in such cases significantly reduces the risk of recurrence after the operation.

Open surgical procedures

  • Retromuscular mesh repair (Rives-Stoppa operation)
  • Per-Umbilical-Mesh-Plasty (PUMP repair)
  • Direct suture closure

Minimally-invasive procedures

  • Mesh implantation via laparoscopy between the peritoneum and abdominal wall muscles (TAPP, eTEP)
  • MILOS procedure (Minimal or Less Open Surgery): less invasive procedure for the treatment of umbilical and incisional hernias with a small incision, mesh position retromuscular
  • SCOLA (Subcutaneous Onlay Laparoscopic Approach)

Hospital stay: 2 days
Umbilical hernias without mesh: outpatient if necessary

Incisional Hernias

Incisional hernias develop in scars of the abdomen following abdominal surgery (e. g. laparotomy, appendectomy, gall bladder removal). The scar tissue is not as stable as the natural abdominal wall and prone to develop a hernia defect. For example, one year after laparotomy almost 20% of patients develop an incisional hernia. Incisional hernias usually cause symptoms such as the dull pain and a clearly visible and palpable bulge. Due to the symptoms and quite fast progression of the hernia size an operation is mostly always necessary. The aim of the operation is a tension-free closure of the abdominal wall defect and the perfect restoration of the abdominal wall anatomy. In all cases the hernia should be closed using a suture with a reinforcing mesh. The used surgical techniques are depending on the size and localization of the incisional hernia. Our standard procedure is the MILOS technique (mini less open surgery), where the hernia is operated through a small incision (4-5cm) over the hernia. In larger hernias the surgical technique needs to be adapted. To plan the procedure perfectly, we usually perform a computer tomography (CT scan) before surgery.

Open approaches

  • Retromuscular mesh reinforcement (Rives-Stoppa)
  • Preperitoneal umbilical mesh placement (PUMP operation)

Minimally-invasive approaches

  • Extraperitoneal mesh implantation using laparoscopy (TAPP, extended TEP)
  • MILOS operation (Minimal or Less Open Surgery)

Hospital stay: 2—4 days

Large ventral hernias (>8cm hernia diameter)

In the case of very large hernias (larger 8cm in diameter) a tension-free closure of the abdominal wall is difficult and sometimes not possible without additional measures. An elegant option is to pre-treat the lateral abdominal muscles with botulinum toxin A (so-called Botox). The medication is injected into the lateral abdominal muscles 4 weeks before the operation (under ultrasound control). These muscle groups then relax at their maximum after 4 weeks, which usually allows the large hernia to be closed without tension. In a few cases, a so-called component separation is necessary, in which an additional dissection of the lateral abdominal wall muscles is required during the operation, to achieve a tension-free closure of the abdominal wall.

Surgical techniques

  • Open retromuscular mesh insertion Rives-Stoppa
  • Endoscopic, posterior or anterior component separation (ECS, TAR)

Diastasis recti (Deviation of the rectus muscles)


Diastasis recti is a separation of the abdominal rectus muscle of more than 2 cm at the level of the belly button. This muscle separation produces a longitudinal bulge of the abdominal wall in the midline. Especially women after pregnancy are affected by this condition. About 2/3 of woman are suffering from diastasis recti following childbirth. In 1/3 of the cases the diastasis recti persists despite intensive physiotherapy. Frequent symptoms are back pain, trunk instability, abdominal wall muscle pain and sometimes urine incontinence. In contrast to widespread assumptions, diastasis recti can only be cured with surgery. Physiotherapy can only help to reduce the symptoms of small diastasis recti.

The concept of the surgical treatment consists of anatomical restoration of the abdominal wall. Usually, the rectus muscles are re-adapted using suture, in many cases a mesh is placed behind the rectus muscle for reinforcement of the suture. In large cases of diastasis recti women complain about cosmetic problems too (e.g. excessive skin folds, wrinkles, stretch marks). Here, and abdominal­plasty can additionally be done. In such cases we perform the operation together with our trusted plastic surgeon Dr. med. Rik Osinga.

  • Physiotherapy
  • ELAR operation (endoscopic linea-alba reconstruction)
  • Plastic surgery (e.g. abdominoplasty)
  • MILOS (Mini Less Open Surgery)

Hospital stay: 2—4 days

Sportmans groin

Pain in the groin during sports is a very common problem. Sports such as hockey, soccer, tennis, badminton, or long-distance running are prone to this problem. In most cases an overload of the musculoskeletal system or joints are responsible for the pain. Here we frequently find strains of the adductor and iliopsoas muscles. Sometimes, an inflammation of the pubis bone (osteitis pubis) or a femoro-acetabular impingement (FAI) can cause the groin pain. However, in 15-20% of the cases an instability of the posterior wall of the groin is responsible for the pain. During exercising the lax posterior wall of the groin bulges into the inguinal canal and causes compression of the nerves. This nerve compression is causing the typical pain during sports in the groin. The pain has typically a stabbing, sometimes electric character and radiates from the groin down into the testicles, labia and / or the proximal thigh. Diagnosis can be established with a careful physical examination, interdisciplinary work up, and imaging modalities (MRI, ultrasound). Once the diagnosis has been established and other causes for the pain outside the groin are excluded the treatment consists of surgical stabilization of the posterior wall of the inguinal canal. We usually perform a laparoscopic TAPP repair using a mesh. Two weeks after surgery the training can be initiated again with close cooperation of a physiotherapist.

  • Physiotherapy
  • Open approach: minimal-repair
  • Minimally-invasive approach (TAPP, TEP)

Hospital stay: 2 days
Outpatient treatment in unilateral hernias if applicable

Chronic postoperative inguinal pain (CPIP)

Chronic groin pain can develop with and without previous inguinal hernia repair. When the pain occurs without prior surgery the most frequent causes are pathologies of the muscles, of the pelvic bones, of the lumbar spine, of the genitals, or intestinal structures. In contrast to widespread assumptions inguinal hernias don’t cause groin pain, except from an acute incarceration of bowel in the hernia. When chronic groin pain develops after inguinal hernia repair and last longer than three months, we speak of a chronic post operative inguinal pain syndrome (CPIP). In total about 6-8% of patients suffer from CPIP. The reason for CPIP is mostly an inadvertent damage of one or more of the three sensitive nerves in the groin, usually due to suboptimal surgical technique. This explains the lower rates of CPIP in specialized hernia centers such as ZweiChirurgen, where CPIP rates are less than 1%. In a few cases CPIP can occur due to ingrowth of the nerves in scar tissue of the sutures or the mesh. Besides surgical expertise, diagnostic and treatment of CPIP demands a careful physical examination, detailed medical history taking, and the use of imaging modalities (MRI). Also, a pain mapping should be performed to get a clear understanding of the problem and the affected nerves. In some cases, repeated infiltration of the groin with a long-acting local anesthetic agent can induce continuous pain reduction (“desensibilization”). In some cases a percutaneous nerve ablation or a surgical neurectomy (with or without mesh removal) is necessary to treat CPIP successfully. The overall success rate for treating CPIP is 75-80%.

  • Interdisciplinary diagnosis and treatment (Radiology, pain specialist, physiotherapy, hernia specialist)
  • Pain mapping
  • Infiltration of local anesthetics
  • Laparoscopic and open neurectomy

Hiatal hernia (diaphragmatic hernia)

A hiatal hernia is a widening of the esophageal opening through the diaphragm. A distinction is made between different degrees of severity (types I-IV), with type I hiatal hernia being the most common. In this case, the hernia is not particularly large, but the sphincter muscle at the junction of the esophagus and stomach no longer functions properly. This causes stomach acid to rise into the esophagus (so-called reflux), which can then trigger the typical heartburn (burning pain behind the breastbone). In most cases, treatment with acid blockers can help to alleviate the symptoms. In some cases, surgery is required. In type II-IV hiatal hernias, abdominal organs (parts of the stomach, intestines) ascend through the hernia into the chest (thorax). The main symptoms here are a feeling of pressure, breathing difficulties, vomiting, etc. These hernias almost always require surgery.

The diagnosis is made by means of gastroscopy, CT and contrast swallowing. The treatment concept then depends on the symptoms and the type of hiatal hernia. If surgery is necessary, it is always performed using a minimally invasive approach.