[Function of the abdominal wall and development and therapy of hernias (among others: the para-colostomy hernia)].

The peritoneal cavity has a fascial skeleton with musculature that is nearly always active, i.e. it has resting tone activity. During pneumoperitoneum this resting activity increases very markedly. The pelvic floor and its integrated sphincters also have a similar type of spontaneous activity depending on Onuf's nucleus in the spinal cord together with the somatic and autonomic nerves. Hernias such as umbilical hernias develop with disruption of a scar. While in a child the common inguinal hernia develops in an open vaginal processus, in an adult it develops as the result of a congenital muscular defect in the abdominal wall. A femoral hernia develops in a gap through the pressure of the resting activity of the abdominal wall. A paracolostomy hernia develops after an incision in the fascial skeleton and after pull-through of a very adipose sigma-mesosigma. It can often be treated it by pulling a slim colon segment through the innervated rectus muscle incision and closing the gap in the fascial skeleton with a running suture. Incisional or umbilical hernias can be successfully treated by suturing with a continuous nonabsorbable thread. The best therapy for inguinal hernias is suturing of the hyperplastic fascia transversalis and the reconstruction of the muscle sphincter mechanism. Bassini operated on very large hernias with hyperplastic fascia, thereby achieving excellent results. Fascial hyperplasia has been shown to follow the use of tissue expanders.