A hernia can sometimes reappear after surgical repair. Understanding why this happens is important for those who have experienced a hernia and are concerned about future occurrences. Factors related to the initial surgery, as well as individual health and lifestyle choices, can influence the likelihood of a hernia returning.
What is a Recurrent Hernia?
A recurrent hernia is a new bulge or weakness that develops at or near the site of a previous hernia repair. This means the abdominal wall, which was surgically reinforced, has weakened again, allowing internal tissues or organs to push through.
While most hernia surgeries are successful, a hernia can return months or even years after the initial procedure. This reappearance indicates that the structural integrity of the repaired area has been compromised. It is a recognized complication in the long-term management of hernias.
Surgical Factors in Recurrence
The method and materials used during the initial hernia repair significantly influence the risk of recurrence. Mesh repair techniques generally result in lower recurrence rates compared to non-mesh repairs, especially for groin hernias. For instance, some studies indicate non-mesh repairs can have recurrence rates as high as 20% compared to 6% for mesh repairs.
The characteristics of the surgical mesh also play a role. The type, size, and placement of the mesh are important for the repair’s strength and longevity. Inadequate mesh fixation or using a mesh that is too small can contribute to the repair’s failure over time.
The specific surgical technique employed by the surgeon, including their expertise, can impact the outcome. An inadequate initial repair, where the underlying weakness is not fully addressed or the repair is not strong enough, can lead to a return of the hernia.
Post-operative complications, such as surgical site infection or hematoma, can also weaken the repaired area. These issues can impair proper wound healing and compromise the integrity of the surgical repair, increasing the chance of recurrence.
Individual Factors Contributing to Recurrence
Beyond surgical considerations, several individual health and lifestyle factors can stress the repaired area, leading to a hernia’s return. Increased abdominal pressure is a significant factor. Conditions that cause chronic coughing (e.g., COPD or allergies), chronic constipation, or difficulties with urination can repeatedly strain the abdominal wall.
Engaging in heavy lifting or strenuous activities too soon after surgery, or using improper lifting techniques, can place excessive stress on healing tissues. This can compromise the surgical repair before it has fully integrated. Returning to demanding physical activities without proper guidance can directly contribute to recurrence.
Obesity is another factor, as excess weight, particularly around the abdomen, increases pressure on the abdominal wall. Individuals with a higher Body Mass Index (BMI) face increased recurrence risks; for example, a patient with a BMI over 35 might have a 27% chance of recurrence, compared to 8.3% if their BMI is under 25.
Smoking can impair the body’s ability to heal and strengthen tissues. It can hinder collagen synthesis, important for building strong connective tissue. Chronic coughing, common among smokers, further strains the abdominal wall. Smokers are reportedly four times more likely to experience a recurrent hernia after surgery. Some individuals may also have an underlying weakness in their connective tissues, making them more prone to recurrence.
Steps to Reduce Recurrence Risk
Individuals can take steps to minimize the risk of a hernia recurring after surgical repair. Managing chronic conditions that increase abdominal pressure is important. For example, controlling a chronic cough helps reduce strain on the abdominal wall. Addressing chronic constipation can prevent repeated straining.
Maintaining a healthy weight is another important measure. Excess body weight, particularly abdominal fat, places continuous stress on the repaired area. Achieving and maintaining a healthy weight reduces this pressure, lessening the chance of the hernia returning.
Quitting smoking is beneficial for tissue health and overall healing. Smoking impairs the body’s ability to repair itself and can contribute to tissue weakness. Ceasing smoking improves blood flow and collagen production, which are important for a robust repair.
Adopting proper lifting techniques is also important to protect the abdominal wall. When lifting objects, bending at the knees and using leg muscles rather than straining the back or abdominal muscles helps to distribute pressure safely. Following the surgeon’s post-operative instructions regarding activity restrictions and gradual return to normal activities is also important. This allows the body sufficient time to heal and for the repair to strengthen.