A hernia repair with mesh is a common surgical procedure designed to reinforce weakened areas in the abdominal wall. The mesh acts as a scaffold, providing immediate support and encouraging the body’s own tissue to grow into and around it, creating a stronger, more durable repair. Patients frequently wonder if the condition can return even after this reinforcement. The answer is yes, a hernia can recur after a mesh repair, though modern techniques have made this less common. The use of prosthetic mesh is considered the standard approach for many hernia types because it significantly reduces the likelihood of the hernia returning compared to traditional tissue-only repairs.
Understanding the Likelihood of Recurrence
The potential for a hernia to recur after mesh repair is a known factor, but the rates are generally low, especially when compared to non-mesh surgeries. Studies have consistently shown that using mesh dramatically decreases the chance of recurrence, which can be as high as 8% to 10% with tissue-only repairs, also known as primary suture repairs. Mesh repairs, in contrast, often show recurrence rates in the range of 1% to 5% for common hernias like inguinal (groin) hernias.
These statistics vary based on the hernia’s location. Incisional or ventral hernias—those that occur at the site of a previous surgical incision—often have higher recurrence rates than inguinal hernias. The mesh functions by providing a tension-free repair, meaning the surrounding tissues are not pulled together tightly, which can lead to failure over time.
Factors That Increase Recurrence Risk
While mesh substantially lowers the baseline risk, several factors related to the patient and the surgery itself can increase the chance of recurrence.
Patient Factors
Patient-specific factors often involve conditions that place excessive strain on the surgical repair or impair the body’s ability to heal properly. Conditions that chronically increase intra-abdominal pressure, such as severe chronic coughing (often seen in smokers or those with COPD) or chronic constipation, can stress the mesh boundary over time.
Obesity is another patient factor, as excess weight increases pressure on the abdominal wall and is associated with poorer tissue quality and healing. Chronic illnesses like diabetes can compromise the wound healing process, making it more difficult for the mesh to fully integrate with the native tissue. Smoking is particularly detrimental because it impairs circulation and the body’s collagen production, which is necessary for a strong biological incorporation of the mesh.
Technical Factors
Surgical and technical factors also play a substantial role in the success of the repair. An inadequate overlap of the mesh beyond the edges of the hernia defect is a common technical cause of failure, as the mesh can pull away from the boundary under pressure. If the mesh is not properly secured, or if the fixation points fail, it can lead to mesh migration or a localized recurrence. Furthermore, a postoperative wound infection can compromise the mesh, sometimes necessitating its removal, which leaves the repair site vulnerable to a new hernia.
Managing a Recurrent Hernia
When a hernia recurs, it typically presents with symptoms similar to the original hernia, such as a noticeable bulge or discomfort at or near the site of the previous repair. The diagnosis is often confirmed through a physical examination, although imaging studies like ultrasound or CT scans may be used to assess the exact location and size of the recurrence, especially in relation to the previously implanted mesh.
Repairing a recurrent hernia is often a more complex surgical challenge than the initial operation due to the presence of scar tissue and the prior mesh. Surgeons must carefully consider the approach, as operating through the original incision can be difficult due to dense scarring. For instance, a recurrence following an open repair may be best addressed with a laparoscopic approach, which allows the surgeon to work from the back side of the abdominal wall, away from the scarred area.
Subsequent repairs may involve using a different type of mesh, such as a synthetic mesh with different properties or, in cases of infection or complex tissue loss, a biological mesh. A technique known as transversus abdominis release (TAR) is sometimes employed for complex ventral recurrences. This involves separating layers of the abdominal wall to achieve a tension-free closure with a larger, well-placed mesh. The goal of managing a recurrence is to select a surgical strategy that utilizes a new, clean tissue plane to reinforce the abdominal wall, providing the best chance for a durable long-term outcome.