A hernia occurs when an internal organ or fatty tissue pushes through a weakened area of muscle or connective tissue, typically in the abdominal wall. Surgical repair is necessary to correct this defect. The standard approach often involves using surgical mesh, a specialized screen-like material. The primary purpose of this mesh is to reinforce the compromised tissue, acting as an internal scaffold to provide long-term strength to the repair site. Patients undergoing this common procedure often worry if the hernia can reappear, and this article explores the factors that contribute to recurrence even after mesh implantation.
The Likelihood of Hernia Recurrence
The direct answer to whether a hernia can return after mesh repair is yes, though the risk is substantially lower than with non-mesh, suture-only techniques. Mesh repair significantly reduces the chance of recurrence, sometimes by as much as 50% compared to older methods. The exact rate depends heavily on the hernia’s location and the specific type of hernia.
For the most common type, the inguinal (groin) hernia, recurrence rates following mesh repair are low, ranging from 0.5% to 5% over the long term. Ventral hernias, which occur on the abdominal wall, present a more complex challenge and have a higher likelihood of returning, sometimes reaching 16% or more. Despite the possibility of recurrence, long-term data supports the use of mesh as the most effective method for achieving a durable repair.
Surgical Technique and Mesh Selection
The technical execution of the surgery and the choice of prosthetic material are significant factors that influence the outcome. A common mechanism for failure is inadequate mesh placement, which includes insufficient overlap beyond the edges of the original tissue defect. If the mesh is too small or improperly secured, abdominal pressure can cause it to fold, twist, or migrate away from the weakened area.
The method of securing the mesh is also important, as improper fixation can allow the repair to shift, particularly immediately after surgery. Mesh selection, whether synthetic (like polypropylene) or biologic, influences the body’s reaction. Some materials, such as certain biologic or resorbable synthetic meshes, have been associated with higher recurrence rates in ventral hernia repair. This occurs because they may degrade before the body’s own tissue achieves sufficient strength.
Furthermore, the development of a hematoma or seroma—a collection of blood or fluid—can physically lift the mesh away from the abdominal wall. This prevents proper tissue integration and leads to recurrence.
Patient Health and Lifestyle Risk Factors
Biological and external factors specific to the patient play an important part in the success of the long-term repair. Any activity that consistently increases pressure within the abdominal cavity can place excessive strain on the mesh and surrounding tissue. This includes chronic coughing, severe straining due to constipation, and strenuous activities like heavy lifting.
Underlying health issues, known as comorbidities, can directly impair the body’s ability to heal and integrate the mesh into the muscle wall.
Comorbidities
Conditions such as diabetes, which compromises blood flow and immune response, and connective tissue disorders, which affect the natural strength of the body’s tissues, are recognized risk factors. Abnormalities in pulmonary function can also increase abdominal pressure and strain the repair site over time.
Lifestyle Factors
Lifestyle habits also impact the healing process and the longevity of the repair. Smoking is a detriment because nicotine constricts blood vessels, restricting the necessary blood flow and oxygen required for tissue repair. Obesity significantly increases intra-abdominal pressure, which acts as a constant outward force on the mesh. Addressing these modifiable factors through weight management and smoking cessation reduces the likelihood of recurrence.
Treatment Options for Recurrent Hernias
When a recurrence is suspected, the initial step involves a thorough clinical examination. This is often supplemented with imaging tests like ultrasound or CT scans to precisely locate the new defect. This evaluation helps determine the size of the recurrence and its relationship to the previously implanted mesh.
Treatment for a recurrent hernia typically requires a second surgical procedure. This operation is often more complex than the first due to the presence of scar tissue and the prior mesh. Surgeons frequently choose a different surgical approach or anatomical plane from the original operation to avoid scarred tissue and find a new, strong layer for reinforcement.
For large or complex recurrent ventral hernias, specialized techniques like the Transversus Abdominis Release (TAR) procedure may be used. This allows for a new, tension-free placement of a larger mesh. If the recurrence is small, asymptomatic, or the patient has significant health risks, watchful monitoring may be recommended instead of immediate re-operation.