What is a recurrent hernia?
Why do hernias reappear or recur?
Are recurrent hernias repaired in the same way as first time hernias?           

What is a recurrent hernia?
A recurrent hernia is a hernia that reoccurs or reappears in the same place as a previous hernia repair.  If the swelling appears very near to the scar from the previous repar or operation it is almost never a “new” hernia.

If it recurs does it mean I did I something wrong or was the operation done wrongly?
Not really.  But see below for detailed explanation:


Why do hernias reappear or recur?

a) after the old type of sutured repair.
With a sutured repair sutures or stitches bring the edges of the hole together. Like lacing up a shoe tightly so that the two edges of the gap touch. The suture material is strong non-absorbable nylon-type material - a bit like fishing line, and in certain situations the strong sutures may eventually cut through the tissues – like shoe laces cutting through the leather.

The edges of the new hole are often ragged and become scarred and more rigid than normal tissue. There is also often some loss of tissue so that the edges of the hole are now further apart than they were originally.

You can see how this makes further repairs more difficult, and more likely to fail again if the same technique is used.

b) why should a hernia come back after mesh has been used?
The simple answer is that the mesh is no longer covering the hole.

The original mesh may have been just the correct size, and has now shrunk slightly (most meshes do this anyway – which is why you have to have an overlap) or it may have moved to expose a corner of the hole or it may have simply become detached on one edge.

Mesh moving out of position is that commonest reason for a failed keyhole or laparoscopic repair.

When repairing any hernia, using any technique,  a piece of mesh much larger than the defect should be used with a wide overlap, and it needs to be attached properly.


Are recurrent hernias repaired in the same way as first time hernias?
Some surgeons do, but I don’t agree.  Nowadays the feeling is that after a failed repair, the redo should use a different technique, with the mesh placed in a different layer of the abdominal wall.  So if you had an open operation with a cut on the skin and mesh over the hole, the next operation should put the mesh behind the abdominal wall.  A keyhole (laparoscopic) or open pre-peritoneal repair is the most suitable way of doing this.           

Are there any special problems or risks with recurrent hernia surgery?
There are some technical issues – operating through scar tissue and possible old mesh.  But the problem that concerns most people is the theoretical risk of damage to the blood supply to the testicle when re-operating through the same incision.  The risks are small – less than 2-4% is the quoted figure – but much rarer in my experience.  It is why recurrent hernias are best operated on through a new incision or by keyhole surgery away from the scar tissue from the previous operation.