A hernia occurs when tissue or an organ pushes through a weak spot in a muscle or connective tissue, creating a noticeable bulge. Surgical repair typically addresses this issue, but a hernia can reappear months or even years after the initial operation. When a hernia returns at or near the site of a previous repair, it is known as a recurrent hernia.
Understanding Recurrent Hernias
The abdominal wall, previously strengthened by surgery, can develop another weakness allowing internal contents to protrude again. Recurrent hernias can manifest with symptoms similar to the original hernia, such as a noticeable lump or discomfort. Common types prone to recurrence include inguinal hernias, found in the groin, and incisional hernias, which develop at the site of a past surgical incision.
Why Hernias Return
Several factors can contribute to a hernia’s return following surgical repair. Patient-related elements, such as chronic coughing, persistent straining from constipation, or obesity, can increase pressure within the abdomen, stressing the repaired area. Poor nutrition, diabetes, or underlying connective tissue disorders can also impair healing and weaken tissues, making recurrence more likely. Heavy lifting or strenuous activity too soon after surgery can also strain the abdominal wall before it has fully recovered.
Surgical factors also play a role in recurrence. If the initial repair technique created too much tension on the tissues, or if the repair material, such as mesh, was not properly secured, the hernia may reappear. Infection at the surgical site can compromise healing and increase the risk of recurrence. The characteristics of the initial hernia, such as a very large size or a history of multiple previous repairs, can make subsequent recurrences more probable.
Potential Dangers and Complications
Recurrent hernias can lead to several complications, some of which require prompt medical attention. A concern is incarceration, where the protruding tissue, often part of the intestine, becomes trapped within the hernia sac and cannot be pushed back into the abdomen. If incarceration persists, it can progress to strangulation, a condition where the blood supply to the trapped tissue is cut off. This lack of blood flow can cause tissue death (necrosis), infection, and potentially lead to life-threatening conditions like sepsis if not addressed immediately.
A recurrent hernia involving the intestine can also result in a bowel obstruction, blocking the passage of food and waste. This can cause symptoms such as severe abdominal pain, nausea, vomiting, and an inability to pass gas or have a bowel movement. Chronic pain is another common issue with recurrent hernias, often more severe due to scar tissue from previous operations. Repairing a recurrent hernia is often more challenging than an initial repair due to altered anatomy and the presence of scar tissue, leading to longer, more difficult surgeries and higher complication rates.
Treatment and Urgent Care
Treatment for a recurrent hernia typically involves surgical repair, as hernias do not resolve on their own and tend to enlarge over time. Surgeons often use synthetic mesh to reinforce the weakened area, which can significantly lower recurrence rates compared to repairs without mesh. While watchful waiting might be considered for very small, asymptomatic hernias, surgery is generally recommended due to the increased risk of complications. Laparoscopic (minimally invasive) approaches are often preferred for recurrent hernias because they allow surgeons to operate through tissue not previously dissected, potentially reducing complications.
It is important to seek immediate medical attention if certain symptoms develop, as they could indicate a medical emergency like incarceration or strangulation. These signs include sudden, severe pain at the hernia site that intensifies quickly. Other urgent symptoms are tenderness or redness around the bulge, fever, nausea, vomiting, or an inability to pass gas or have a bowel movement. A hernia that becomes firm, tender, or cannot be pushed back in, especially if it appears dark or purple, requires prompt evaluation.