What is a Recurrent Hernia?
A recurrent hernia is when a hernia develops at the same site of any prior hernia repair. There are many factors that can contribute to a recurrence. These may include:
The Type of Hernia Repair
Traditional conventional repairs, where the defect in the fascia is closed using sutures and not a mesh, are a leading cause of recurrence. In the past, prior to the availability of mesh, all hernias were repaired this way. Because the tissue is pulled together and stitched, there is inherent tension created at the repair site. Further, the stitches can cause tissue weakness (necrosis), which causes surrounding tissue to become weaker and easier to tear. Sometimes, when force is applied to this form of repair, it can simply reopen. Today, almost all hernias are repaired using a tension-free method that employs mesh to cover the defect. Small umbilical hernias may still be repaired without a mesh.
The Type of Mesh Being Used
Older less advanced meshes had a greater tendency to shrink or move (migrate) after surgery. When a mesh shrinks or moves, it may not cover the hernia defect as well and a recurrence of the hernia may result. The meshes of today have vastly improved from the earlier mesh designs. Modern day meshes are customized to the patient’s hernia and are built from a lighter, more durable material. They tend to keep their shape and do not migrate or move. You may also wish to learn about biologic and/or absorbable mesh.
The Size and Fixation of the Mesh
The size of the mesh being placed as well as how the mesh is attached goes a long way in avoiding hernia recurrences. The mesh should be appropriately sized with plenty of overlap on all sides of the hernia defect. It should also be attached sufficiently and appropriately for maximum strength. Surgeon experience is key to ensuring that mesh placement is performed correctly.
Early activity and exercise can cause excess strain on the repair in the early days following the repair. This can increase the likelihood of a recurrence. While mesh is solidly affixed at the time of surgery, the strength of the repair is not sufficient to handle more than light exercise for about two to three weeks. We recommend that patients do not perform strenuous activity for about three to four weeks. The full strength of the repair may take several months.
How to Mitigate Recurrences
Choosing a hernia surgeon that has significant experience performing hernia repairs week in and week out is key to mitigating potential complications and improving outcomes. Choose a surgeon that specializes in hernias and has the knowledge to choose the appropriate technique and mesh for your circumstance.
Discuss various repair techniques with your surgeon and understand the risk of recurrence of each. Generally, mesh repairs have a significantly lower recurrence rate than non-mesh (tension) repairs.
Lastly, take it easy after surgery. There is rarely a reason to rush back to strenuous activity. While the risk of recurrence because of the early activity is relatively low, there is no reason to risk it. Do not perform any activities outside of the scope of what your surgeon tells you and wait for your follow up appointment before moving on to the next phase of your activity levels.