Preventing a Hernia Recurrence

If you’ve had hernia surgery, recurrence is one of the potential long-term complications you’ve undoubtedly heard of. So, what exactly is a hernia recurrence, and how can it be avoided?

Hernia recurrence occurs when the initial defect closure fails, and the contents of the hernia again protrude through the fascia of the abdomen. Hernia recurrence was once widespread when tension-based suture repairs were the norm in this surgery.

Let’s dig a little deeper.

As you may know, a hernia is a tear or a hole in the abdomen’s thin but strong lining, known as the fascia. Fascia does not repair itself like a tear in a muscle or a fracture in a bone would. Instead, the tear worsens until it is corrected surgically. Before the advent of safe and lightweight hernia mesh, most hernia repairs were performed by closing the defect with sutures. However, there are downsides to this.

Most importantly, the tension created by the abdominal contents, known as intra-abdominal pressure, pushes onto the suture repair. Over time, the sutures holding the fascia together may tear the tissue and come loose. This is due to the almost inevitable weakening of fascial tissue over time. So, the first way to help prevent recurrence is by opting for a mesh-based hernia repair which today is the gold standard of care.

*Of note, you may have heard of defective hernia mesh that has been the target of legal ads over the past few years. This mesh is not the same as what is used for hernia repair. Instead, the meshes in question are used for pelvic floor repairs in women. The newer generations of hernia mesh are lighter and more effective than ever.

Choosing an Experienced Surgeon

Mesh hernia repairs are not perfect either, so an excellent way to prevent recurrence is by employing a skilled and experienced surgeon like Dr. Tsuda. While mesh technology has improved dramatically over the past few decades, success still lies with surgeon experience. Each patient has unique anatomy and challenges, so we must approach them differently. We have several mesh types, thicker to thinner, with varying patterns and weaves. Each of these creates a different inflammatory reaction in the abdomen and could be the difference between a successful and unsuccessful repair. Your surgeon must also size the mesh appropriately to minimize the risk of migration or curling. This knowledge comes from experience.

Take Good Care

The next step involves taking care of your hernia repair. When you are given the postoperative instructions of not lifting anything heavy for several weeks and other essential recovery habits, follow them. There’s no rush to return to regular activity after a hernia, so allow your body to recover completely. While our modern self-adhering meshes are far more technologically advanced than older meshes, starting exercise or lifting heavy objects before you are cleared can be problematic and cause complications, including recurrence.

Stop Smoking

Smoking can delay recovery after any surgery, particularly hernia surgery. Smoking reduces oxygenation in the blood and restricts blood vessels which can weaken tissue and, therefore, the hernia repair. Smoking can also increase the risk of infection. We expect patients to stop smoking several weeks before their surgery and strongly suggest they continue their abstinence after surgery.

Losing Weight

Excess weight and obesity are risk factors for developing a hernia, especially inguinal hernias in men. The constant extra intra-abdominal pressure caused by too much weight can quicken the development of a hernia. Patients should make it a point to lose weight by improving their diet and increasing their exercise regimen to burn more calories when cleared.

Is It a Recurrence?

There are many different hernia types, and hernias can occur virtually anywhere in the abdomen. It’s important to remember that a hernia recurrence is a protrusion of the same hernia previously repaired. Patients often confuse new hernias in close but different locations as a recurrence. They are not.

The Bottom Line

With all that said, there are times when a recurrence is unavoidable. Therefore, employing a highly skilled surgeon is essential, as revising a prior hernia repair can be complicated and may even require abdominal wall reconstruction. Dr. Tsuda specializes in repairing primary hernia surgeries that have failed for several reasons. So, if you are experiencing pain or a lump in the area of a prior hernia repair, we encourage you to contact our office to learn more about your options.