Considerations of Hernia Recurrence
Hernia surgery has improved tremendously over the past several decades. Today, repairing a hernia is not only a quick operation but also a very effective and safe one. Advances in surgical technique and medical device technology have made this possible. However, a recurrence is not unheard of, and, depending on the procedure, has a varying degree of likelihood.
Many hernia patients will experience aches and pains for several weeks after surgery. This is especially true for inguinal or groin hernia repairs. There will likely be swelling, too. While some patients may believe that their hernia has recurred, the pain they feel is likely a normal part of the healing process. If the patient develops a bulge or significant pain around the hernia repair, an immediate evaluation by a qualified physician or surgeon is necessary. If the hernia may be strangulated, a trip to the ER is the first course of action.
Which Hernia Repairs are Most Likely to Recur?
Traditional hernia repairs that simply stitch the hernia closed and do not use mesh have the highest rate of recurrence. It is estimated that up to 30% of such repairs can recur. This is because the tissue around the suture can weaken over time and abdominal stress can eventually cause the tissue to tear. For this reason, most hernia surgeons do not advocate a traditional tension repair.
Mesh-based repairs, also known as the tension-free option, do not use sutures to close the hole, rather they cover the hole with surgical mesh. Tension-free repairs have a far lower risk of recurrence, estimated to be less than 2%. The Total Extraperitoneal (TEP) hernia repair, by and large, offers the least chance of recurrence.
We established that hernia recurrences are possible, but what are the most common causes of a recurrence?
Behavior and lifestyle choices that increase the risk of a hernia to begin with put additional strain on the abdomen and may cause a recurrence as well. These include:
- Excess weight or obesity
- Smoking – due to heavy coughing that puts added strain on the abdomen
- Pregnancy
- Lifting heavy weights
- Pulmonary obstructive diseases that cause coughing
- Heavy exercise
- Genetics
Many of these causes can be mitigated by changing lifestyle habits or taking measures to minimize the strain put on the abdomen.
In some cases, problems during surgery for the primary hernia may be the cause of the recurrence:
- First, as mentioned above, using a tension-based repair dramatically increases the chance of a hernia recurrence
- Mesh-based repairs can also recur if the mesh is not properly sized for the patient’s hernia. The surgeon must have a sufficient mesh material on all sides of the hernia to ensure that any pressure put on the mesh does not cause it to fail
- Defective hernia meshes have been implicated in certain cases of recurrence and chronic pain. These meshes were recalled by the FDA many years ago and are no longer on the market
- In very rare cases, the mesh can curl or migrate, thereby exposing the hernia creating a recurrence, and necessitating further surgery
Open vs Laparoscopic
Some patients may wonder if open surgery is more prone to recurrence than laparoscopic surgery. There’s very little definitive evidence showing this to be the case, however, most hernia specialists prefer the laparoscopic approach due to improved results and fewer potential complications. An open repair, depending on the technique, is more prone to an incisional hernia because an inherent weakness is present whenever the muscles of the abdomen are cut during surgery.
How to Avoid Hernia Recurrences
Recurrence of a hernia has become less of an issue in modern hernia repair. Surgical technique and device technology have improved to the degree that complication rates are very low. The statistics quoted regarding hernia recurrence are based on hernia repairs both by inexperienced and experienced hernia surgeons, as well as hernia repairs that were performed under emergency conditions – these procedures typically have less positive outcomes.
To avoid recurrences and other common complications, it is important to employ a hernia specialist – someone with a great deal of experience repairing these defects. Further, statistics show that hernias repaired electively versus in an emergency tend to have better results, including fewer complications.
If you believe you have a hernia recurrence, is important to see a hernia specialist soon, as all the risks of a primary hernia are still applicable to a recurrence. Typically, if the primary hernia is repaired via an open procedure, the recurrence will be repaired using the laparoscopic approach as that offers significantly better outcomes. Some patients will be good candidates for a robotic hernia repair as well.
For more information, we encourage you to contact Dr. Tsuda or Dr. Ryan for a consultation to evaluate your options for repairing a recurrent hernia.
