A hernia occurs when tissue or an organ protrudes through a weak spot in the muscle or tissue wall, most often in the abdomen or groin. Hernia repair surgery pushes the protruding tissue back into place and reinforces the compromised area. While these procedures are generally successful, the fix is not always permanent; a hernia repair can, in fact, come undone.
Defining Hernia Recurrence
The medical term for a hernia that reappears after an initial surgical repair is a recurrence. This means the defect has returned at or near the site of the original operation. Recurrence rates vary significantly based on the type of hernia—such as inguinal, femoral, or ventral—and the surgical method used.
The two main repair techniques are suture-based repair, which closes the defect by stitching tissue together, or mesh repair, which reinforces the area with a synthetic or biological patch. Studies show that using mesh significantly lowers the chance of recurrence. Mesh repairs for inguinal hernias have recurrence rates as low as 2% to 4%, compared to 8% to 10% for non-mesh repairs. For ventral hernias, recurrence rates without mesh can be as high as 70% at five years.
Factors Leading to Repair Failure
Failure of a hernia repair is often due to a combination of patient-specific issues and factors related to the surgical technique itself. Patient factors commonly involve conditions that increase intra-abdominal pressure, which puts strain on the repaired area. Activities like chronic coughing, straining during bowel movements, or heavy lifting too soon after surgery can physically stress the repair.
Underlying health conditions also play a role, as they can compromise the body’s ability to heal effectively. Smoking impairs wound healing by reducing the quality of collagen in scar tissue, increasing the risk of failure. Similarly, obesity and uncontrolled diabetes can lead to poor tissue quality and constant tension on the repair site.
Surgical failure can occur due to technical issues, such as inadequate mesh placement or size. If a mesh is too small or shifts, it may not effectively cover the defect, allowing tissue to push through. Tension-based repairs, where tissues are pulled together with sutures, can fail because the weakened native tissue eventually tears under constant strain. In rare cases, an infection at the surgical site can degrade the mesh or surrounding tissue, weakening the entire repair.
Recognizing the Signs of a Recurrence
Recognizing a recurrence involves noticing symptoms that are similar to those of the original hernia. The most common sign is the reappearance of a bulge or lump at or near the previous incision site. This swelling may be more noticeable when standing, coughing, or straining, and may disappear when lying down.
Patients often experience discomfort, ranging from a dull ache to moderate pain in the area of the former repair. This pain is exacerbated by physical exertion, such as lifting objects or sneezing. Other sensations include a feeling of pressure, heaviness, or fullness in the affected region.
Certain symptoms require immediate medical attention, as they may indicate an acute complication like incarceration or strangulation. These signs include sudden, sharp, and intense pain accompanied by nausea, vomiting, or an inability to pass gas or stool. Such symptoms suggest the trapped tissue has had its blood supply cut off, making it a time-sensitive medical emergency.
Treatment Options for Recurrent Hernias
When a recurrence is confirmed, treatment usually requires another surgical intervention, as the hernia will not resolve on its own. Repairing a recurrent hernia is often more complex than the first procedure due to the presence of scar tissue and any previous mesh. The surgeon selects an approach that addresses the specific cause of the failure and the type of hernia.
The second repair often involves a shift in technique, such as moving from an open repair to a minimally invasive laparoscopic or robotic procedure, or vice versa. For suture-based failures, a mesh-based repair is recommended for the recurrence to achieve a lower re-recurrence rate. If mesh was used initially, the surgeon may opt for a different type of mesh or a specialized technique, such as a component separation, to create a more durable closure.
Before undergoing a repeat surgery, addressing underlying lifestyle risk factors is emphasized to maximize the chance of success. This includes achieving a healthy weight, quitting smoking, and managing chronic conditions like diabetes. Taking these preventative steps before the reoperation is crucial for long-term repair durability.