Center of Excellence in Hernia Repair Surgery

Overview of hernias

What is a hernia?

A hernia is the protrusion of tissue through a weak spot in the surrounding wall of the cavity that normally contains it. Because of this localized 'hole' of the wall, an organ or a part of an organ squeezes into another region of the body. Quite often, this condition results into a visible bulge against the skin.

Depending on where this protrusion takes place there are different kinds of hernias, each requiring a specific management and treatment. By far, the most common hernias develop through various abdominal wall defects.

Common types of abdominal wall hernias

Hernias of the groin
Inguinal Hernia (inner groin)
Femoral Hernia (outer groin)
Hernias of the midline
Umbilical Hernia (navel - belly button)
Epigastric Hernia (midline above the navel)
Incisional Hernia (after surgical incision)

Hernia signs and symptoms

Asymptomatic hernia

Often localized swelling and often visible bulge at the hernia site

No pain or discomfort at most times. Sometimes aching sensation around the area of the hernia

Swelling often enlarges while standing and disappears while lying or manually

Watchful waiting possible
Surgery recommended

Symptomatic hernia

Localized swelling and visible bulge at the hernia site in most cases

Recurrent pain and discomfort, especially during physical effort, laughing, coughing etc.

Swelling often enlarges while standing and may disappear while lying or manually

Surgery strongly recommended

Incarcerated hernia

Painful swelling at the hernia site, very sensitive to local pressure

Frequently occurring pain attacks. Abdominal pain, nausea and vomiting possible

Usually enlargement of previously known bulge. It does not disappear while lying or manually

Urgent surgery required

Strangulated hernia

Very painful swelling at the hernia site, extremely sensitive to pressure

Constant massive pain at the hernia site. Abdominal pain, nausea and vomiting probable

Usually enlargement of previously known bulge. It does not disappear while lying or manually

Emergency surgery required

FAQ: I have been recently diagnosed with a inguinal hernia. I can see and feel the bulge myself but I don't have any discomfort at all. Is hernia repair surgery recommended at this time?

Surgery is recommended for abdominal wall hernias

Leaving an abdominal wall hernia without surgical treatment is not really an option, plenty of clinical studies in the last decades have proven that. Please consider:

No spontaneous healing
An abdominal wall hernia will not heal on its own. There is no way of fixing the 'hole' with some kind of exercise or medication. If the hernia defect is there, it can only enlarge over time making a future surgical repair even more complicated.

Pain and discomfort
Most patients with a hernia will develop discomfort and pain over time, even if the hernia is not causing any symptoms in the beginning. These symptoms can noticeably affect the patient's quality of life and ability to work.

Hernia belts not effective
Non-surgical treatments, such as wearing a belt or corset, will definitely not solve the problem. In fact they can cause additional issues and they are considered to be old-fashioned and in some cases even dangerous.

Strangulation possible
A potentially life-threatening strangulation of the hernia contents can occur any time, if the hernia is left untreated.

FAQ: I have a bulge in my groin, which sometimes gets very painful, especially after exercise. Some time later the symptoms decline. Is that a dangerous condition?

Hernia: a potentially dangerous condition

A hernia of the groin or the abdominal wall is certainly not only an aesthetic issue, because of a resulting visible bulge. The protrusion of tissue into another area of the body is often combined with discomfort and pain, which worsens with increasing intraabdominal pressure (cough, laugh, exercise, etc.) or even automatically with bowel movements.

The main problem, however, is that the tissue inside a hernia can anytime be strangulated and its blood supply can be interrupted. This condition can rapidly lead to permanent damage to intraabdominal organs and even threaten the patient's life.

"hernia repair surgery is highly recommended as soon as the first symptoms appear"

Methods of hernia repair

The abdominal wall hernia is a very common condition, affecting approximately 10% of the population. Hernia repair is the most frequently performed surgery in the world, as millions of hernia operations take place each year. Nowadays, there are several different approaches to hernia repair, some much more successful than others.

Learn more about surgical procedures in hernia repair surgery

Experts in hernia surgery

hernia center of excellence

hernia+ consists of a team of highly qualified, experienced surgeons and other medical experts, who apply standardized, innovative procedures in the field of hernia repair surgery. All associated physicians share a common educational and scientific background and follow consistently strict guidelines, based on current surgical expertise and research findings. This way, we apply the most reliable techniques and provide modern and personalized treatments for each of our patients.

Leading Surgeons

Giorgos Tsiledakis  

General & Laparoscopic Surgeon

  • Head of the Department of General and Laparoscopic Surgery of the Private Hospital Tsepeti in Chania Crete
  • University degree: Medical Faculty Charité - Humboldt University, Berlin, Germany

Stefan Haak  

General & Trauma Surgeon

  • Head of the Department of Orthopedics and Traumatology of the Private Hospital Tsepeti in Chania Crete
  • University degree: Medical Faculty Charité - Humboldt University, Berlin, Germany

Latest development in hernia repair surgery

Mini-open inguinal and femoral hernia repair with preperitoneal mesh implant under local anesthesia

"This well-proven surgical approach is rapidly replacing worldwide all other surgical methods (open or laparoscopic) of inguinal and femoral hernia repair. The reason: it provides great clinical results combined with an unmatched patient comfort during and after surgery"

Mini-open hernioplasty with preperitoneal mesh implant
Anesthesia local, light sedation
Length of skin incision 3 - 4 cm
Duration of surgery 15 - 45 min.
Hospital stay after surgery 3 - 4 hours
Back to simple activities 3 - 4 hours
Back to full activities 3 - 12 days
Recurrence rate < 0.6%
Infection rate < 0.01%


Do you recommend mini-open hernioplasty with preperitoneal mesh over laparoscopy for inguinal hernia repair?

We definitely do. We are experienced surgeons in laparoscopic surgery and we apply laparoscopy almost daily for many different surgical procedures. We have been performing laparoscopic hernia repair for many years as well. Nevertheless, we now strongly recommend mini-open hernioplasty with preperitoneal mesh over laparoscopic inguinal or femoral hernia repair in most cases. It provides the same bio-mechanical results as a laparoscopic repair but it is simpler and easier to perform and it is much more comfortable for the patient.

What are the differences between mini-open hernioplasty with preperitoneal mesh and other widespread open methods in inguinal hernia repair surgery?

There are many open techniques available in inguinal hernia repair surgery. Some use sutures to repair the hernia defect, others use mesh (tension-free). We discuss the advantages and disadvantages of those methods below.

Mini-open hernioplasty with preperitoneal mesh, although an open method, is a different approach, the latest development in inguinal hernia surgery. The main difference is that the mesh implant is placed in the deepest layer of the abdominal wall and not between the muscles, as in any other open conventional method. This provides better bio-mechanics and increased stability for the hernia repair. As a result, patients do not have to avoid extensive physical load for long time, as necessary in other open methods. In addition, the preperitoneal mesh repair provides protection against femoral hernias, that may develop in the future. Conventional open repair methods do not.

What kind of anesthesia do you use?

We usually perform the procedure in local anesthesia in combination with a light sedation. In presence of an anesthesiologist, intravenous analgesic and anxiolytic medication is administered, so that the patient feels no pain or discomfort at all and remains awake during the procedure. This has the advantage, that we can examine the stability of the hernia repair directly on site, as we usually ask the patient to actively press after the mesh has been placed.

Of course, other forms of anesthesia (general, spinal etc.) are possible.

How long does the surgical procedure last?

The duration of the procedure depends on the size of the inguinal or femoral hernia, the presence of possible adhesions with the surrounding tissues and other anatomical conditions. We usually perform mini-open hernioplasty with preperitoneal mesh implant in 15 to 45 minutes. Longer operation times are very uncommon.

How long do I have to stay in hospital?

Mini-open hernioplasty with preperitoneal mesh implant is in most cases an ambulatory surgery, that does not require an overnight hospital stay. Our patients may go home on the same day of surgery, as they feel minimal or no discomfort at all and there is no medical reason for them to stay overnight. We usually discharge our patients 3 or 4 hours after the procedure.

When can I go back to work?

Much quicker than any other procedure in inguinal hernia repair, even laparoscopy. Patients are able to return to simple activities just hours after the procedure and drive a car on the following day. We usually recommend avoiding extensive physical load for just 3 to 12 days after surgery, depending on the type of hernia.

Learn more about surgical procedures in hernia repair surgery