Hernia surgery is a common procedure performed to repair weakened areas in the abdominal wall where organs or tissues may protrude. While most hernia repairs are successful, it is possible for a hernia to return, a condition known as a recurrent hernia. This recurrence can happen months or even years after the initial operation, signifying that the previous surgical repair has failed to maintain its integrity. Understanding the signs, causes, and management of a recurrent hernia can help individuals recognize if their surgery has failed.
Recognizing Signs of Recurrence
A noticeable bulge at or near the original surgery site is a primary indication of a recurrent hernia. This bulge might become more prominent with activities that increase abdominal pressure, such as coughing, sneezing, or lifting. The appearance of this lump can vary in size and may not always be as obvious as the initial hernia due to existing scar tissue from the previous repair.
Individuals might also experience pain or discomfort in the affected area, ranging from a dull ache to more severe pain, particularly during movement or exertion. This pain can manifest at the surgical scar or sometimes in a different abdominal location. A persistent burning or aching sensation at the hernia site can signal that the tissue is under strain.
Other symptoms can include a feeling of pressure, fullness, or bloating in the abdominal region. If the recurrent hernia involves the intestines, digestive issues such as nausea, vomiting, constipation, or difficulty passing gas may occur. A pus or fluid discharge from the surgical scar may indicate an infection or issues with any mesh used in the repair.
Factors Contributing to Recurrence
Several factors can contribute to a hernia recurring after surgery, including patient characteristics and elements related to the original surgical procedure. Patient-specific factors often involve conditions that increase pressure on the abdominal wall or impair tissue healing. Being overweight or obese places excess strain on the repaired area, increasing the risk of recurrence.
Smoking is another factor, as it weakens the body’s ability to heal and can lead to chronic coughing, both of which put pressure on the surgical site. Other medical conditions such as diabetes can also compromise wound healing, making tissues less robust after surgery. Chronic coughing or persistent constipation, which involve repeated straining, can stress the surgical repair over time.
Surgical technique and materials used during the initial repair play a role. If no mesh was used, or if a tension-based repair (stitching tissues together) was performed, the recurrence rate tends to be higher compared to mesh-based repairs. Improper mesh sizing or placement, where the mesh is too small or not adequately secured, can lead to failure. The experience of the surgeon performing the initial operation can influence recurrence rates.
Diagnosing a Recurrence
Confirming a recurrent hernia begins with a thorough medical evaluation by a healthcare professional. The doctor will review the patient’s medical and surgical history, asking about symptoms and their progression. A physical examination is a primary diagnostic step, where the doctor may ask the patient to stand or cough to check for a visible or palpable bulge at or near the previous repair site.
In some cases, especially if the hernia is not easily felt or is complex, imaging tests may be ordered to confirm the diagnosis and assess the extent of the recurrence. Ultrasound is a first-line imaging choice due to its accessibility and lack of radiation, particularly for smaller or less complex cases. For more detailed information, a computed tomography (CT) scan or magnetic resonance imaging (MRI) may be used. CT scans offer detailed views of abdominal structures. MRI provides excellent soft tissue contrast and is useful for assessing mesh integrity and chronic complications.
Management After Recurrence
Once a recurrent hernia is diagnosed, the management approach depends on several factors, including the patient’s overall health, the size and type of the recurrence, and the presence of symptoms. In some mild, asymptomatic cases, a doctor might recommend watchful waiting. However, recurrent hernias often require surgical intervention, especially if they are causing pain, enlarging, or posing a risk of complications like bowel obstruction or strangulation.
Repeat surgery for a recurrent hernia can be more complex due to existing scar tissue and weakened tissues from the previous operation. Surgical options include open repair, laparoscopic repair (minimally invasive with small incisions), or robotic repair. Laparoscopic approaches are preferred for recurrent hernias because they allow surgeons to operate through tissue not previously dissected, which can reduce complications. The use of mesh-based techniques is recommended for recurrent hernias to reinforce the weakened area and reduce the chance of further recurrence.
Even after repeat surgery, continued attention to lifestyle factors can help prevent further recurrences. Maintaining a healthy weight, avoiding smoking, managing chronic cough or constipation, and practicing proper lifting techniques are important measures. Regular follow-up with a healthcare provider is advised to monitor for any new or unusual symptoms.