Tailored Hernia Surgery: The Approach of the Hernia Center Madonnina

“Tailored, or ‘tailor-made’, hernia surgery differs from a standard approach because it does not apply the same technique to every patient. Instead, it starts from the specific characteristics of each individual case in order to identify the most appropriate solution,” explains Professor Campanelli.

While standard surgery follows a predefined pathway, a personalised approach takes into account a range of factors related to the specific hernia, as well as the individual needs of the patient, in order to select the most suitable technique, surgical access and method of repair for that particular situation.

The fundamental principle is that the patient should not have to adapt to the technique the surgeon is most accustomed to performing. Rather, the surgeon should have a comprehensive knowledge of the different surgical options available and identify the most appropriate one for the individual case.

The aim, therefore, is not to adapt the patient to the procedure, but to adapt the surgical strategy to the patient.

There cannot be one surgical technique suitable for all hernias because abdominal wall defects can present in very different ways and within equally varied clinical contexts.

A personalised surgical strategy therefore takes into account several factors, including:

• type of hernia: the location and characteristics of the hernia defect influence the choice of surgical approach. There are several types of hernia, each characterised by a specific location and anatomical features. The most common include inguinal hernia, which affects the groin region; umbilical hernia, which develops around the navel; and epigastric hernia, which occurs in the upper abdomen along the midline between the navel and the sternum;
• complexity of the case: large hernias, recurrent hernias, multiple defects, or cases that have already undergone surgery may require more complex planning;
• individual patient characteristics: age, tissue quality, overall health and any coexisting medical conditions may influence surgical decision-making;
• surgical history: previous operations may have altered the anatomy of the abdominal wall and can therefore affect the choice of surgical approach;
• lifestyle: type of work, sporting activity and the way the patient’s daily life is organised are relevant when defining the goals of surgery and recovery;
• patient needs: in addition to repairing the hernia, it is important to consider the patient’s expectations and recovery pathway in order to identify a solution that is consistent with their individual situation.

At the Hernia Center of Casa di Cura La Madonnina, the choice of surgical technique is the result of a structured diagnostic and specialist assessment pathway designed to identify the most appropriate treatment for each patient. The pathway includes several stages.

Specialist consultation

The first step is a specialist consultation in General Surgery, during which information is collected regarding:

• symptoms and how they have evolved;
• the patient’s personal and family medical history.

The medical history allows the doctor to assess:

• any previous surgery;
• coexisting medical conditions;
• current treatments;
• lifestyle habits.

The physical examination allows direct assessment of:

• the abdominal wall;
• the characteristics of the hernia.

Assessment of the hernia

When necessary, the clinical assessment is complemented by the most appropriate diagnostic investigations, selected according to the individual case. The aim is to determine precisely:

• the location and size of the defect;
• its relationship with surrounding structures;
• the condition of the abdominal wall.

In more complex cases or in recurrent hernias, a more detailed assessment may be essential for surgical planning.

Choosing the surgical approach

Once the assessment has been completed, the most suitable repair technique is selected. Depending on the characteristics of the hernia and the patient, the following approaches may be considered:

• robotic surgery;
• laparoscopic surgery;
• open surgery.

The choice is not based on a preference for one technology over another, but on which approach is most likely to provide an effective and safe repair in that specific case.

Choosing the Hernia Center at Casa di Cura La Madonnina means being cared for by a team with specific expertise in the diagnosis and treatment of abdominal wall hernias. Dedicated expertise makes it possible to manage both straightforward and more complex or recurrent cases, selecting the most appropriate solution on an individual basis.

An integrated specialist pathway also allows the patient to be followed through every stage of care, from the initial assessment and selection of the surgical technique through to postoperative follow-up, with the aim of ensuring continuity of care and a personalised treatment approach.