Surgery

The range of services on offer in the practice includes the diagnosis of abdominal complaints (stomach problems) and the clarification of hernias in the groin or the naval or in scars.

Changes to the body's surface such as abscesses, fibromas and birthmarks are also included in this, as are wounds which heal poorly after operations and diabetic foot.

The treatment of symptoms diagnosed can be conservative or operative.

Conservative methods are used for inflammations and infected wounds.

Where there is no increased risk for the patient, operations are carried out in an outpatient environment. This means that the patient can go home after the operation. From the point at which the patient is discharged from the operation centre, I am available as a contact for my patients around the clock. It is also possible for patients to be admitted for one to two days after operations under general anaesthetic. This is always recommended if the patient would be alone at home after the anaesthetic.

Local anaesthetic is administered by the surgeon carrying out the operation.

General anaesthetic by means of a laryngeal mask or intubation is given by a specialist in anaesthesia.

I carry out all operations under general anaesthetic in the "Outpatient Operation Centre Munich North (AOZ)". While the patient is waking up, he or she is monitored by the anaesthetist, The patient can then be picked up and taken home.

All hernia operations and all deep or extensive proctological operations (see proctology) such those on as anal fistulas, deep anal fissures, haemorrhoid operations using various different methods, operations on deep anal fissures and anal polpys, are carried out under general anaesthetic.

Hernias

With a hernia, the intestine pushes through a weak spot in the wall of the stomach. The cause of this may be weakened muscles, a weakness in the connective tissue or increased pressure inside the abdominal cavity.

This occurs, for example, when coughing and sneezing, when carrying heavy objects or when pushing hard (for example when evacuating the bowels. If there is a rupture, there can be a visible or palpable bulge on the outside of the body.

Typical types of hernias are:

Inguinal hernia

The inguinal hernia, at a natural weak spot in the wall of the inguinal canal, through which the spermatic cord runs in men and the retinaculum of the womb in women run. Ninety percent of inguinal hernias occur in men.

Naval hernia

Also known as umbilical hernia. Occurs in the region of the naval and can either be congenital or acquired. The cause can be a weak point in the wall of the stomach or the regular overloading of the stomach muscles. Naval hernias occur to an increased level in pregnant women.

Scar hernias

Each scar is a weak point at which ruptures can occur even many years after the operation.

 

Stomach ruptures never heal themselves. If an operation is not carried out to close the rupture, the hole will expand and fatty tissue or intestinal loops can get stuck. This is very painful, and in the worst case scenario can be a life-threatening complication. Painful ruptures have to be closed in an operation. Bandages are not an alternative.

Ruptures to the stomach wall can be stitched using surgical sutures. This is the classical method. The alternative, which is most commonly used today, is to treat the rupture with a plastic mesh or plastic plug.

This is known as the relaxed method. These meshes specially manufactured from mesh or stopper-shaped plugs have been used successfully to achieve a minimal suture stress for more than 40 years.

There are two different operative techniques in which a mesh is generally inserted into the body to repair the rupture.

In the "open technique", the operation is carried out through a small incision in the skin.

In the "endoscopic or keyhole technique", the instruments are inserted through several small openings in the stomach.

The success rate for the stressless operation is almost the same, regardless of whether it is carried out as an open or endoscopic operation.

I only carry out open operations on these ruptures, as the equipment costs are considerably lower. I use all of the recommended techniques, and use stressless methods almost exclusively, whether this is mesh or plugs.