Surgery is often the best solution for painful hernias. Yet, even after a successful operation, hernias can sometimes return. It is essential to understand why these recurrences occur and how to prevent them effectively.
What Is Recurrent Hernia?
A hernia occurs when an internal organ or tissue pushes through a weak spot in a muscle or fascia, creating a visible bulge under the skin. While most hernia repair surgeries are successful, a recurrent hernia happens when this bulge reappears at or near the site of a previous hernia surgery. This recurrence can occur at any time, from days or weeks after the initial surgery to even decades later, indicating that the abdominal wall has weakened in that area once again.
What Causes Hernias to Come Back?
A recurrent hernia can happen for many reasons, some of which may not always be clear. Common causes include:
- Poor Healing: If the body does not heal adequately after the initial repair, the surgical site may not regain sufficient strength, leaving it vulnerable to recurrence.
- Weak Fascia: The natural weakness of the patient's fascia (connective tissue) can contribute, as it may not be strong enough to maintain the repair's integrity over time.
- Infection: Post-operative wound infection can compromise the strength of the repair, significantly increasing the risk of the hernia returning.
- Surgical Technique or Materials: An improper initial surgical technique, inadequate closure of the defect, or the use of unsuitable mesh (in terms of quality, type, or fit) can all lead to a weakened repair and subsequent recurrence.
- Increased Abdominal Pressure: Conditions that consistently raise pressure within the abdomen, such as being overweight, chronic coughing (e.g., from smoking), and frequent heavy lifting or strenuous activities (especially too soon after surgery), can strain the repaired area.
- Underlying Health Conditions: Diabetes and taking immune-suppressing medications can impair the body's healing capabilities, making recurrence more likely.
Signs and Symptoms of a Recurrent Hernia
The signs and symptoms of a recurrent hernia are often similar to those of the original hernia. Common tell-tale signs to look out for include:
- Noticeable bulge at or near the previous repair site
- Pain or discomfort, especially when lifting heavy objects or straining
- Feelings of fullness or pressure in the area
- Nausea or vomiting
How Dangerous Is a Recurrent Hernia?
Ignoring recurrent hernias is dangerous, as they can lead to more serious and complex problems than the initial hernia. When left untreated, a recurrent hernia can result in various complications, including:
- Incarceration: This happens when the herniated tissue gets trapped and cannot be pushed back in. It is very painful and can cause bowel obstruction and increased pressure on the surrounding area.
- Strangulation: This life-threatening condition occurs when blood flow to the trapped tissue is cut off. If not treated immediately, strangulation can lead to tissue death, infection, or even sepsis.
Diagnosing a Recurrent Hernia
Diagnosing a recurrent hernia typically begins with a thorough physical examination and a detailed discussion of your symptoms and surgical history. Your doctor will inquire about previous hernia repairs and your general health to identify any potential risk factors.
To fully understand the extent and exact location of the recurrence, especially if it is not immediately apparent, your doctor may recommend imaging tests such as:
- CT scan
- MRI
- Ultrasound imaging
Treatments for Recurrent Hernias
Surgical intervention, often termed hernia revision surgery, is necessary to repair these recurrences. This type of surgery can be more complex than the initial repair because of existing scar tissue from the previous operation and further weakened tissue in the affected area.
Surgical options for recurrent hernias include:
- Open Hernia Repair: This traditional method involves making an incision over the hernia to directly push the bulging tissue back into place and reinforce the weakened area, often with mesh.
- Laparoscopic Hernia Repair: This is a minimally invasive procedure that uses several small incisions and a camera to guide instruments, typically offering quicker recovery and less discomfort.
- Robotic Hernia Repair: This is an advanced form of laparoscopic surgery where the surgeon utilises robot-assisted technology for enhanced precision during the repair.
- Complex Hernia Repair: This specialised technique is employed for large, difficult, or multiple recurrent hernias, involving advanced methods like component separation to create a more durable and robust abdominal wall reconstruction.
Recovery time after recurrent hernia surgery varies depending on the specific procedure performed and your overall health. Many patients can go home the same day. While you might resume light daily activities within one to three weeks, it is crucial to attend all scheduled follow-up appointments to monitor your healing progress.
How to Prevent Hernia Recurrence
Preventing a hernia from recurring after surgery involves a combination of careful post-operative management and long-term lifestyle adjustments. To minimise the risk of recurrence:
- Prioritise Rest & Avoid Strain: Allow ample healing time by resting; avoid heavy lifting and activities that strain your abdomen, especially post-surgery.
- Maintain a Healthy Weight: Reducing excess weight lowers pressure on the abdominal wall, supporting the repair's integrity.
- Adopt Healthy Habits: Quit smoking to prevent chronic coughing, and engage in regular, doctor-approved exercise to strengthen your core.
- Manage Chronic Conditions: Effectively control issues like persistent coughing or constipation that can increase abdominal pressure.
Conclusion
Hernias can be treated, but they may recur due to factors like weak fascia, infection, and poor healing. Additional risks, such as obesity, smoking, and heavy lifting, can also increase the chance of recurrence. This highlights why proper surgical technique and consistent aftercare are crucial.
If you notice any symptoms or changes, be sure to consult a hernia surgeon, as recurrent hernias can be successfully managed with professional care.