Sometimes, hernia patients who have undergone surgery are shocked to find that a bulge has started developing again at the site of the surgery or in the area surrounding it. While other complications like infection or bleeding can cause this symptom too, another possible complication is that the hernia has occurred again, i.e., the recurrence of a hernia.
With the recent use of novel techniques and prostheses (like meshes), recurrence is not very common (0.2%-10% globally, with the lowest rates at specialized hernia centers); however, if they do occur, they require reoperation.
Here, at Chennai Hernia Centre, our experts are proficient in hernia surgery, with very low rates of recurrence, but also have experience in treating cases that present with recurrence after initial surgery elsewhere.
What causes recurrent hernias?
Recurrent hernias can be quite simply understood as a breakdown of previous hernia surgery. Previous hernia surgery breakdown can happen due to multiple reasons, which are often not clearly distinguished. Some causes are:
- Infection from the surgery
- Not taking adequate rest/being too active after surgery
- The general health of the patient (concomitant illness, aging, etc)
- Chronic cough
- Smoking
- Obesity
- Inadequate previous surgery
Due to the nature of these hernias, your initial hernia surgery must be performed well, with careful follow-up. Dr. Rengan at Chennai Hernia Centre has decades of experience with hernia surgery with very low rates of recurrence, and is, therefore, best suited for all your hernia needs.
How do I know if my hernia is recurring?
The recurrent hernia is very similar to the original hernia, occurring at the same site or near the surgical site. Like all hernias, they are a bulge that may be painless. However, due to the cause of the hernia (infection, tissue breakdown, etc), there may be the presence of pain. Pain, like in all hernias, is a cause for concern and requires attention from medical professionals. Apart from these, be on the lookout for:
- Nausea
- Vomiting
- Fever
- Constipation
All of the above require urgent medical attention, especially if they occur suddenly in concomitance with pain, as it can signal hernia strangulation, a situation in which the bowel loop involved in the hernia is cut off from the blood supply.
What will be done for me at the clinic?
At first, a detailed history will be collected from you including your entire medical and surgical history. Following this, the recurrent hernia will be examined carefully. Our doctors will also try to establish the cause of the hernia at that point. Ultrasound imaging (or in some cases, CT or MRI) will be required for further evaluation of the extent of the hernia. Since these hernias occur over a site of surgery, they are not purely the prior hernia, but also involve aspects of incisional hernias. All this requires careful evaluation and planning for the subsequent surgery. Apart from the imaging tests, some blood tests will also be prescribed. After evaluating all these parameters, we will have a detailed conversation with you regarding your surgical options.
I don’t want surgery again. Can I avoid it?
Unfortunately, a recurrent hernia is not a simple complication that can be treated by medicines or lifestyle measures alone. With the breakdown of the initial surgery, the risks faced by the patient subsequently increase. Therefore, the best course of action is to reoperate, this time with a prosthesis for reinforcement, to ensure that failure of surgery does not recur again.
What surgery can be done?
The choice and type of surgery will be decided based on many factors including your current medical condition, what surgery was previously done, the area involved by the hernia, as well as the cause of recurrence. Surgeries are broadly divided into:
- Laparoscopic surgery: aka Keyhole surgery, in which multiple small incisions are made in the area to pass some thin devices through. These devices can be used to visualize the area and manipulate the organs and tissue to perform the required reparations. The devices are then removed and the incisions are sewn up with minimal blood loss. While laparoscopic surgeries are usually more time-consuming for the surgeon, they provide the benefits of quicker recovery and fewer complications for the patient. However, this type of surgery is not performed for massive defects or emergencies because it can lead to poor results.
- Open Surgery: the traditional model of surgery where a large incision is made to reach in and perform the repair. This is usually the option of choice for large defects and emergencies and usually requires a longer stay than key-hole surgery. Sometimes, a tube will have to be left in after the surgery.
In general, for recurrent hernias, the original scar will be avoided and the hernia approached through a higher incision to reduce further risk of scar weakness and recurrence.
What happens after the surgery?
Both types of surgery are done under general anesthesia and may only require admission for a couple of days depending on your other medical factors. Importantly, return to daily activities must be carefully monitored to avoid undue strain on the incision site. If factors like chronic cough or other conditions complicated recovery the previous time, these factors will be addressed specifically as well. Similarly, follow-up will be done carefully and rigorously. Please make sure to attend the follow-up visits as instructed.