Recurrent Hernia

Overview

What is it? The majority of hernia repair surgery is successful. In a small percentage of cases though, the hernia might come back, months or even years after the initial operation. When this happens, we call this new hernia a “recurrent” hernia. Although the mechanics and the physiology of recurrent hernias is similar to that of primary hernias, there are some unique characteristics of recurrent hernias that need to be considered.
Why it happens: A recurrent hernia can develop for many different reasons, broadly grouped as follows:
– Those related to the surgical technique and the mesh or the sutures used in the primary operation.
– Those related to the patient, their lifestyle and their activities. Obesity, smoking, diabetes, use of medication that prohibit healing (such as steroids) and regular heavy weight lifting are all factors predisposing to a recurrence of a hernia.
– Those related to the hernia itself
Frequency: Recurrent hernias develop in between 0.5 and 15% of all hernia operations.

Symptoms

A recurrent hernia most commonly presents as a bulge or lump at or near the site of the original hernia. The lump may or may not be painful. A recurrent hernia can cause bloating or constipation and even nausea, vomiting and bowel obstruction.

Diagnosis

In many cases a recurrent is self-diagnosed correctly as many patients are able to correlate the new lump to the one they had once the primary hernia developed. A careful medical history and a physical examination will confirm the hernia. For recurrent hernias most surgeons will request some imaging modality, either an ultrasound or a CT/MRI, not only to confirm the diagnosis but also to map the area of the defect as accurately as possible.

Treatment

Most surgeons will probably recommend a repair of a recurrent hernia unless the patient is entirely asymptomatic or not fit to undergo surgery. This is because recurrent hernias have a slightly higher chance of strangulation as a result of the scar tissue from the previous operation. The surgical approach will depend on the site of the hernia, the size of the defect, the type of repair that was done previously and the individual characteristics of the patient.
Most surgeons would agree that when repairing a recurrent hernia a mesh is more likely to be required regardless of whether a mesh was used or not in the initial operation. There are few exceptions to this rule. Likewise, unless specifically not indicated, a revision of a previous repair should use a different approach to the one used before (open approach for a previous lap and vice versa).
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Follow Up

If you had surgery for recurrent hernia

  • It is important to follow all your doctor’s instructions, take any medication prescribed regularly and keep your follow-up appointments.

  • Getting out of bed and walking is an important part of recovery and helps prevent complications.
  • Most surgeons would agree that when repairing a recurrent hernia a mesh is more likely to be required regardless of whether a mesh was used or not in the initial operation. There are few exceptions to this rule. Likewise, unless specifically not indicated, a revision of a previous repair should use a different approach to the one used before (open approach for a previous lap and vice versa).
  • It is very important to avoid heavy lifting and any other strenuous activity. Ask your doctor what types of activities are safe and for a timed plan on when to resume your normal lifestyle. You should also ask when you can return to work which will depend on the type of your job.
  • Do not drive before you feel safe to emergency break – check with your insurance company for any small prints in your policy
  • You should be prepared for a slightly longer period of rest and reduced activities compared to your original hernia operation.
If you have a hernia that is asymptomatic and you and your doctor decided to watch it
  • Take steps to avoid becoming constipated. Eat lots of fibre, drink plenty of fluids, exercise, and go to the bathroom when you feel the urge.
  • Try avoiding heavy lifting and other strenuous activity whenever possible.
  • Call your doctor if your hernia symptoms get worse or if the bulge becomes bigger.
Seek immediate medical attention if
  • You have a painful bulge that can’t be pushed back inside.
  • If you have increasing pain, swelling, or redness.
  • If you have nausea, fever, or vomiting along with hernia pain.