Recurrent hernias involve the reappearance of the hernia defect after a previous repair. They do not refer to new or separate hernias that form in a different area of the abdomen. Hernia recurrence is less common with a mesh-based hernia repair (1-3%). They’re more common when the hernia has been repaired using a non-mesh surgical repair (15+%). We do not yet have significant long-term data for recurrence rates of absorbable mesh.
Causes and Symptoms of a Recurrent Hernia
By definition, patients experiencing a recurrent hernia have had an initial hernia repair before. They will, therefore, recognize the signs and symptoms of a recurrent hernia, which are very similar to the original hernia – a lump which may or may not be accompanied by pain.
The causes of hernia recurrence very significantly and can include
- The migration, shrinkage or distortion of the hernia mesh. This is more common with older meshes.
- The initial surgeon not placing a large enough piece of mesh over the defect. An experienced surgeon will ensure that there is plenty of overlapping mesh material beyond the edges of the hernia defect.
- The failure of a no-mesh tension hernia repair. Even though the wound is sutured closed, it remains a weak part of the abdomen which increases the risk of recurrence. Further, the tissue round the sutures is weakened and can eventually give way. This is not the case with the mesh, as the material actually reinforces the repair.
- Lifestyle issues such as smoking, obesity, diabetes and use of steroids
- Obstructive pulmonary disorders that cause a significant, chronic cough
- Continuing to lift excessive weight
Treatment for Recurrent Hernias
We almost always repair a recurrent hernia with the laparoscopic or robotic surgical approach. Sometimes, due to a complex repair or multiple recurrences, rebuilding the abdominal wall may be necessary. This is usually performed in conjunction with a specialized reconstructive surgeon. And while prevention is best, by minimizing pressure on the abdomen and improving lifestyle considerations, there are times that a recurrence is unavoidable. No matter what causes the recurrence, employing a highly skilled and experienced surgeon to perform the follow-on surgery is critically important as it can be more complex that the primary hernia surgery was.